pel 




LIBRARY OF CONGRESS. 

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i^.Y^ §opjttg|i **♦-— 

UNITED STATES OF AMERICA. 

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Showing the Course of the Principal Blood Vessels. 
See page 67. 



WHAT TO DO FIRST 



IN 



Accidents and Emergencies, 



A MANUAL 

EXPLAINING THE TREATMENT OF SURGICAL AND OTHER 
INJURIES IN THE ABSENCE OF THE PHYSICIAN. 



BY 




CHARLES Wi^DULLES, M.D., 



FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA; SURGICAL 

REGISTRAR TO THE HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA ; 

SURGEON TO THE OUT-DOOR DEPARTMENT OF THE PRESBYTERIAN 

HOSPITAL, IN PHILADELPHIA, ETC. 






SECOND EDITION, REVISED AND ENLARGED. 



WITH NEW ILLUSTRATIO 




PHILADELPHIA: 

P. BLAKISTON, SON & CO., 

No. 1012 Walnut Street. 

1883. 






Entered according to Act of Congress, in the year 1883, by 

P. BLAKISTON, SON & CO., 

In the Office of the Librarian of Congress, at Washington, D. C. 



TABLE OF CONTENTS. 



PAGE 

Preliminary Remarks 9-11 

Obstructions to Respiration 12-19 

Drowning 12 

Strangulation * 16 

Suffocation 16 

Choking . 17 

Foreign Bodies in the Eye, Nose and Ear 20-23 

Fits or Seizures 2 4~33 

Unconsciousness 24 

Fainting 28 

Hysterics 29 

Epileptic Fits 30 

Convulsions in Children 31 

Apoplexy 32 

Intoxication 32 

Catalepsy 33 

Injuries to the Brain 34 

Effects of Heat , 35 

Burns or Scalds 35 

Sunburn 37 

Sunstroke, or Heatstroke 37 

Heat Exhaustion , 38 

Lightning Stroke 39 

Effects of Cold 40-41 

Sprains 42-43 

Dislocations 43-45 

Fractures 46-51 

iii 



IV ♦CONTENTS. 

PAGE 

Wounds 52-60 

Contusions 52 

Contused Wounds 53 

Incised Wounds :.. 53 

Lacerated Wounds 54 

Punctured Wounds 55 

Splinters 56 

Poisoned Wounds 57 

Gunshot Wounds 59 

Railroad and Machinery Accidents 61-66 

Hemorrhage — Bleeding 67-77 

Special Hemorrhages V8-79 

Transportation of Injured Persons 80-82 

Poisons 83-93 

Domestic Emergencies 94-100 

Cholera Morbus 95 

Vomiting or Nausea 95 

Diarrhoea 95 

Croup 96 

Whooping Cough 97 

Asthmatic Attacks 97 

Nervous Attacks 98 

Toothache 98 

Earache 99 

Poisoning with Poison Vine 100 

Signs of Death ., 101-103 

Supplies for Emergencies 10^-116 

Surgical Case 104 

Use of Contents of Surgical Case 105 

Bandaging 105 

How to Make Poultices 109 

Medicine Chest , in 

Doses and Uses of the Medicines 112 



PREFACE TO THE SECOND EDITION. 



The fact that the first edition of this little book 
has been for some time exhausted, and an observa- 
tion of the present widespread public interest in the 
acquirement of just such information as it was in- 
tended to convey, have led the author to the con- 
clusion that a second edition might prove not only 
useful but timely. 

In preparing this, so much new matter has been 
added, and so many new illustrations, that the result 
is practically a new book. In its present form, it is 
hoped it may be fitted to fill a wider sphere than 
before ; and that, while it may still lead no one into 
the error of presumption it may increase the real 
helpfulness of larger numbers and more varied classes 
in the community. 

If the author may be permitted to suggest the way 
in which the instrument he has constructed ought to 
be used, it is as follows : Let it be read over, at 
least once, as carefully and as studiously as possible, 
so that the reader may make the acquaintance of its 



* 

vi PREFACE TO THE SECOND EDITION. 

suggestions ; and then let it be kept in some handy 
place, where it can be referred to immediately when 
an emergency arises. In order to make it available 
for sudden necessity, pains have been taken to make 
the index as complete as possible, and the typography 
has been so arranged as that leading words may 
catch the eye on every page. 

Philadelphia, May, 1883. 



PREFACE TO THE FIRST EDITION. 



Whoever has seen how invaluable, in the presence 
of an accident, is the man or woman with a cool 
head, a steady hand, and some knowledge of what is 
best to be done, will not fail to appreciate the 
desirability of possessing these qualifications. To 
have them in an emergency, one must acquire them 
before it arises, and it is with the hope of aiding any 
who wish to prepare themselves for such demands 
upon their own resources that the following sugges- 
tions have been put together. They are not meant 
to be elaborate, but simple and practicable. They 
cannot take the place of calling a physician or sur- 
geon, but may fill up with helpful action what might 
otherwise be a period of inaction and despair, before 
skilled assistance arrives. With this view I trust 
they may prove of some value to the public, to whom 
they are offered. 

vii 



ACCIDENTS 



AND 



EMERGENCIES 



PRELIMINARY REMARKS. 

There is nothing so important in the presence of 
an accident or emergency as that some one with 
coolness and information enough should assume 
command and begin to set things right. Such an 
one will rarely fail to be recognized by those less 
efficient, and will usually find little difficulty in so 
directing them that they shall render some valuable 
assistance, or, at least, do no harm to the sufferer. 
Bystanders should first be urged not to crowd ; to 
leave room for breathing and action. Any scream- 
ing or wailing should be stopped, if possible. Then 
enough, and no more persons than are needed, 
should be called on to assist in removing the one in 
danger, or if. he be crushed, in removing whatever 
presses upon him. Next his body should be placed 
in a comfortable position, lying down, with the 
head a very little raised ; after which an investi- 
b 9 



10 ACCIDENTS AND EMERGENCIES. 

gation may be made to find out, as nearly as pos- 
sible, what is wrong, and a line of subsequent action 
decided upon. 

Some one should now be dispatched for a doctor, 
with a written message, if possible, and certainly 
with one that shall give the doctor a good idea of 
what he may expect to find when he arrives, so that 
he may come provided with necessary instruments. 

While awaiting him, whatever may be advisable is 
to be done by those at hand. Clothing may have 
to be loosened or removed, efforts at resuscitation 
made, a stretcher provided, or other means of trans- 
portation. Hot or cold applications may be needed 
and should be got ready. Temporary splints or 
means to control bleeding may be required. These 
the bystanders ought at once to attend to. One thing, 
however, they ought not to do. That is, to give 
large quantities of whisky or brandy, as is the almost 
invariable custom with people who know nothing, 
but want to do something. If stimulants seem to be 
called for, the non-medical had better stick to hot 
tea or coffee, or milk; for alcoholic stimulants, 
except in small quantities, are, as a rule, not only 
unnecessary, but actually harmful. They often 
injure the patient, mislead the doctor, and interfere 
with the proper treatment of the case. . 

Exceptions to this general statement may be dis- 
covered ; but they are exceptions — this is the rule. 
- Another important point to be observed is, not to 



PRELIMINARY REMARKS. 11 

do too much. It will be making a bad use of in- 
structions designed to bridge over the interval 
between the occurrence of an accident and the com- 
ing of one whose whole time is given to the work of 
healing, if one who knows no more than can be 
gleaned from a little manual should act as if it had 
made a veritable doctor of him. Such presumption 
might lead to great mortification of the amateur and 
great injury to the sufferer. The true principle is, 
when the urgency is pressing, to do what is known 
to be helpful, and when one is not sure, to do 
nothing. 



12 ACCIDENTS AND EMERGENCIES. 



Obstructions to Respiration. 

Drowning. It may seem almost absurd to say- 
that the first thing to be done when one has been 
exposed to drowning is to remove the person from 
the water. Yet I well remember to have seen, some 
years ago, the revolting spectacle of a woman's 
body, fastened with a rope, floating in a river, and 
gazed at by hundreds of curious people. Upon 
inquiry, a policeman gravely informed me that no 
one dared take it out before the arrival of the 
Coroner. This is a mistake; any one who thinks 
there is a chance of resuscitation should remove 
from the water a person presumed to have been 
drowned, and at once set about the work. 

If Natural Breathing has ceased, the first thing 
to be done is to free the body from any clothing 
that binds the neck, chest or waist, turn it over 
upon the face for a moment, thrusting a finger 
into the mouth and sweeping it round, to bring 
away anything that may have gotten in or accumula- 
ted there. Then the body should be laid out flat on 
the back, with something a few inches high under 
the shoulders (anything will do : a folded blanket, 
or shawl, or coat, or a stick of wood), so as to cause 



DROWNING. 



13 



the neck to be stretched out and the chin to be car- 
ried far from the chest. The tongue should now be 
drawn well forward out of the mouth and held by an 
assistant, or, if there be no one to do this, a pencil or 
small stick may be thrust across the mouth on top of 
the tongue and back of the last teeth, to keep the 
mouth open and the tongue out of the throat. An 
effort to secure artificial respiration should now 
be begun. The simplest way to do this is for some 
one to place himself on his knees behind the head, 
seize both arms near the elbows and sweep them 
round horizontally, away from the body and over 
the head till they meet above it, when a good, strong 
pull must be made upon them, 
and kept up for a few seconds. 
This effects an inspiration — fills 
the lungs with air, by drawing 




Fig. i. 



the ribs up, and so enlarging the cavity of the chest. 
The second manoeuvre consists in returning the arms 
to their former position alongside the chest, and mak- 
ing strong pressure against the lower ribs, so as to 



14 



ACCIDENTS AND EMERGENCIES. 



drive the air out of the chest and effect an act of 
expiration. This need occupy but a second of time. 

If this plan is regularly- 
carried out it will make 
about sixteen complete 
acts of respiration in a 




Fig. 2. 

minute. It should be kept up for a long time, and 
not abandoned until a competent person has ascer- 
tained that the heart has ceased to beat. The cessa- 
tion of the pulse at the wrists amounts to nothing as 
a sign of death ; and often life is present when only 
a most acute and practiced ear can detect the sound 
of the heart. In a moderately thin person, deep 
pressure with the finger ends just below the lower 
end of the breast bone may sometimes reveal pulsation 
in the aorta, the main artery of the body, when it 
cannot be found anywhere else. 

It is important that the wet clothing shall be re- 
moved as soon as possible from a drowned person. 
This can always be done without interrupting the 
artificial respiration. If exposure must be avoided, 
something may be laid over the body (a coat, a 
shawl, a blanket, a sail), and the wet clothes 



DROWNING. 15 

loosened under it and drawn down over the feet. 
Then the body may be quickly slipped on to some- 
thing dry, and covered with some other fabric, if 
the first has become wet, while this, in its turn, is 
pulled away from underneath. 

Warmth is to be secured by any means which in- 
genuity may suggest — hot bottles, or plates, or bricks, 
or stones, or even boards that have lain in the summer 
sun. At the seashore there is plenty of hot sand, 
and often plenty of baking bathing costumes. The 
body and limbs may be gently, but constantly, rubbed 
toward the heart, to help the blood in its labored 
circulation. None of these things need interfere 
with the efforts to secure respiration, which must be 
uninterrupted. 

Some stimulant is to be given as soon as it can be 
swallowed. Teaspoonful doses of whisky or brandy, 
in a tablespoonful of hot water, may be given every 
few minutes, till the danger point is passed. 

As natural respiration begins to be attempted, it 
should be aided as much as possible by timing the 
artificial to it. It may be stimulated by applying 
smelling salts, or hartshorn, to the nose, by slap- 
ping the skin, or by dashing hot water upon the 
chest. Little by little it will take the place of this, 
but must not be left unwatched for some time. 

Nothing but danger from cold or pressing necessity 
should prompt the removal from one place to another 
of a person who is being resuscitated, before this has 



16 ACCIDENTS AND EMERGENCIES. 

been thoroughly accomplished. If it cannot be 
avoided, it must be done with great care. After 
resuscitation the person should be put in a warm bed, 
being carried carefully, with the head low, and a 
watch kept to see that the breathing does not sud- 
denly stop. 

Where natural breathing has not ceased, all the 
steps just described should be carried out, with the 
exception of artificial respiration. But this should 
be had recourse to upon the first evidence that natural 
respiration is failing. 

Strangulation, by hanging, or by anything 
which compresses the windpipe from the outside, is 
to be treated by re-establishing the respiration in 
the same way as for drowning. The obstruction is, 
of course, to be removed and natural respiration 
stimulated or artificial respiration employed. 

Suffocation with Noxious Gases or Vapors 
calls for instant removal to the fresh air and the 
establishment of natural respiration, or of artificial 
till the natural is re-established, as described in 
speaking of Drowning. Gases like carbonic acid, 
the fumes of charcoal, and the collections in 
mines, wells or privies, are very dangerous to 
life. The removal of a person from a well full of a 
poisonous gas is a very difficult and delicate matter. 
Some attempt may be made to dislodge or dissipate 
the gas. Buckets of water may be dashed down, or 
an open umbrella lowered by the handle and rapidly 



OBSTRUCTIONS TO RESPIRATION. 17 

drawn up a number of times. But these efforts must 
not consume any more time than is required to pre- 
pare a man who can be lowered, securely fastened to 
the rope, so that he can attach another rope to the 
person overcome in the well. The rescuer must be , 
brave, cool and strong, and those who lower him no 
less so. He may be somewhat protected by wearing 
a sack over his head, or having a thick vail over 
his face. But everything will depend upon the 
rapidity with which he and his comrades can do 
their work. 

Choking caused by something sticking in the 
throat, gullet or windpipe demands its removal as soon 
as possible. It is not always easy to tell which of 
these latter passages is clogged, but usually there is 
active irritation, with coughing, when a foreign 
body lodges in the windpipe, while swallowing can 
be done quite readily. On the other hand, when the 
gullet is stopped it is usually impossible to swallow, 
and there is little or no tendency to cough, no matter 
how much the breathing may be interfered with. 
About the throat, it is not so hard to tell, for one can 
usually see or feel with the finger the offending body. 

If a foreign body be within reach of two fingers, 
it may be pretty easily removed. If not, a pair of 
blunt-pointed scissors may be used like forceps. Or 
a hair pin may be straightened out and one end 
bent round so as to make a loop, and this used to try 
to dislodge the foreign body ; or the handle of one 



18 ACCIDENTS AND EMERGENCIES. 

blade of a pair of scissors may be used in the same 
way. It has been stated that for foreign bodies in 
the throat, such as pieces of meat, etc., a simple 
mode of relief is to blow forcibly into the ear. This 
sometimes excites powerful reflex action, during 
which the foreign body is expelled. Such a plan is 
so easy of execution that it is certainly worth trying. 

Children not infrequently get buttons, or coins, 
or marbles in their throats, and come near choking 
to death. These may often be pulled out, or expelled 
by vomiting, if this can be provoked. Holding the 
body up by the legs, with the head hanging down, 
has sometimes aided other efforts to get rid of such 
things. The responsibility of attempts to poke them 
down may well be left for the surgeon. 

If pins, or needles, or fish bones, get stuck in the 
mouth or throat, it is sometimes an extremely deli- 
cate matter to remove them. Sometimes, on the 
other hand, they may be grasped with the fingers or 
a pair of blunt scissors — used like forceps — and pulled 
out. If this cannot be done, the patient should be 
made to lie down, and kept as quiet as possible in 
body and mind, till some one comes who can give 
relief.* 

If foreign bodies get into the windpipe they will 
soon be coughed out, or require surgical skill for 
their removal. A moderate blow on the back with 

* The practice, by adults, of putting pins in the mouth, is neither clean 
nor safe, and is to be discountenanced for both these reasons. 



OBSTRUCTIONS TO RESPIRATION. 19 

the open hand, or a quick strong squeeze of the 
chest, sometimes aids the coughing act ; and invert- 
ing the body may assist in dislodging the foreign 
body if it be not too tightly wedged in. 

In any case where the breathing is not seriously 
interfered with, it will be most prudent for non- 
medical persons to keep " hands off." For there 
may no longer be anything in the throat, though 
it appears there is ; and it can do no good to make 
groping efforts to bring away foreign substances that 
have already gone down into the stomach, only leav- 
ing behind an irritation which deceives the patient 
and his friends. 

When strange things, like coins, or marbles, or slate 
pencils, or nails, are swallowed by children (or adults), 
it is a mistake to give a purgative. The proper plan 
is to let the bowels alone and to give plenty of good 
solid food, so that the foreign body may be surrounded 
with the waste and carried out of the body without 
injuring the walls of the intestines. 



20 ACCIDENTS AND EMERGENCIES. 



Foreign Bodies in the Eye, Nose 
and Ear. 



Foreign Bodies in the Eye. Small substances 
like cinders, dust or small chips of stone or metal, 
can usually be removed from the eye by very 
simple means. Sometimes there is at once a free 
flow of tears which washes them out. At others, 
the common way of catching the upper lid by 
the lashes and pulling it away from the eyeball 
and down over the lower lid, then letting it go so 
that as it recedes its under surface is swept by the 
lashes of the lower lid, will clear it out. 

If this does not prove successful, a loop made of a 
horse hair, or a long human hair, can be passed under 
the lid and swept, from the outer side, toward the 
nose and drawn down. This may serve the purpose. 

If it does not the upper lid must be everted, or 
turned inside out. This is easy to do. One way is 
to seize the lashes between the thumb and first finger, 
and to draw the edge of the lid away from the eye- 
ball. At the same moment the end of the second 
finger is pressed against the skin of the lid above its 
edge. The patient is now told to look down, and, as 



FOREIGN BODIES IN EYE, NOSE AND EAR. 21 

he does so, the lashes and edge of the lid are pulled 
upward toward the eyebrow, while the upper part is 
tucked under it with the end of the second finger. 
Another plan is to take a slender pencil, or knitting 
or crochet needle, and place it against the eyelid, 
parallel to and above the edge, and then to pull the 
edge up and turn it over this by means of the lashes. 

In this way a large part of the eyeball and eyelid 
can be examined and any foreign substance removed. 
A magnifying glass is sometimes needed to see frag- 
ments that have given a great deal of trouble. 

One must be on his guard against the sensation 
which is sometimes left after a foreign body has 
been removed from the eye. It often feels to the 
sufferer as though this were still in his eye when it is 
not. But a most careful search should be made 
before this is taken to be a self-deception ; and even 
then it would be better to consult a more skilled 
person. 

After removing a foreign body from the eye, the 
irritation may be sufficient to demand cool, wet 
applications, or even anodynes. Nothing is better 
than a thin mucilage of pure, clean gum-arabic poured 
freely in the eye. Or, a little laudanum may be 
poured into a heated cup, and when evaporated to a 
kind of jelly it can be thinned out with clear water 
and this poured into the eye. A bandage, loosely 
applied so as to shut out light and keep the eyeball 
rather quiet, often does much good. 



22 ACCIDENTS AND EMERGENCIES. 

When lime gets in the eye it burns very severely. 
At once the eye should be deluged with water, and a 
little vinegar or lemon juice and water (a teaspoon - 
ful of vinegar or lemon juice to a teacupful of water) 
poured over the eyeball. 

Foreign Bodies in the Nose. Children 
sometimes place, or have placed, in their noses 
small bodies, such as marbles, buttons, peas, beans 
and other small grains. To get rid of them, 
the nose should be blown hard ; or, sneezing may be 
excited by tickling the nose or giving snuff; or, the 
child may be told to take a full breath and then be 
given a smart blow on the back. Some one of these 
plans may dislodge the foreign body. If it does not, 
reasonable efforts may be made to fish it out with a 
bent hair-pin, a bodkin, the handle of a mustard or 
salt spoon, or something of that sort. But these efforts 
must not be rough or prolonged ; for they may do 
much damage ; and if a surgeon must be called, the 
sooner it is done the better. The longer it is de- 
layed, the harder will be his work and the worse for 
the child. In case peas or beans are lodged in the 
nose, the danger is increased by the fact that if they 
absorb any moisture, they swell up and are very diffi- 
cult to get away. 

Foreign Bodies in the Ear. The removal 
of foreign bodies from the ear is more delicate 
than when they are in the nose, because there 
is no way of getting at them from behind, and 



FOREIGN BODIES IN EYE, NOSE AND EAR. 23 

there is no natural force to be called to one's assist- 
ance. Consequently it usually requires special in- 
struments. Yet, if no medical man be attainable at 
all, and if it be remembered that the outer passage 
of the ear is very deep and very delicate, something 
may be done. 

If the body be a metal or mineral one, the ear 
maybe syringed out thoroughly. The person's head 
must be held with the face down, as in this position 
gravity lends some assistance. Very gentle efforts 
may even be made to remove any foreign body with 
a crochet needle, or a bodkin, or an ear spoon, if it 
can be had. But with all these it must be remem- 
bered that great damage may be done by the least 
roughness. 

If live insects get into the ear, oil or glycerine 
or salt and water should be poured in. Or, a plug 
of cotton soaked in a strong solution of salt and 
vinegar may be placed in the ear and the head turned 
over on that side. 

An ingenious method, which has sometimes been 
successful, is to turn the ear at once to a bright light, 
so as to tempt the insect to back out, on account of 
the attraction which light has for all these creatures. 



24 ACCIDENTS AND EMERGENCIES. 



Fits or Seizures. 



Unconsciousness, or Insensibility, occurs 
in many different conditions, and it is of great 
importance that something should be known about 
them by those who meet many strangers, or have 
the care of large numbers of employees. To this 
class belong railway officials and railway servants, 
manufacturers, superintendents of mines and public 
works, surveyors, constructors, and policemen. The 
former might often do priceless service to those who 
come under their care, and the latter might escape 
much blame and avoid some unfortunate mistakes, if 
they could always distinguish disease from disorder 
and drunkenness. 

This, it must be acknowledged, is often hard to do. 
But so much the more reason is there for attempting 
to learn enough to prevent such shameful mistakes as 
are sometimes made. So, before speaking of the 
treatment of conditions when unconsciousness may 
be present, a little space may be devoted to consider- 
ing, in a general way, how one may decide what 
unconsciousness is due to. 

For our present purpose the causes of unconscious- 



FITS OR SEIZURES. 25 

ness may be classified as : disorders of the circulation, 
disorders of the brain, poisoning, and intoxication. 

Unconsciousness due to Disorder of the Cir- 
culation, or temporary failure of the heart, is fami- 
liarly illustrated in fainting. This may be brought 
about by a simple nervous influence, or by a sudden 
shock, or by loss of blood. In any case, the condi- 
tion is easily recognized by itself or from its cause. 

Unconsciousness due to Disorder of the 
Brain may depend upon disease or injury. Disease 
of the brain is recognizable, from its gradual approach, 
which can be learned from the sufferer's friends, and 
is not much more likely to prove perplexing than is 
fainting. , On the other hand, injuries of the brain 
are usually accompanied by external signs, such as 
dirt, swelling, bruises or cuts, which show that 
violence has been inflicted; or, they occur under 
circumstances which make a suspicion of violence 
reasonable. In apoplexies some of the external evi- 
dences might prove misleading, but besides these 
there is often found an unequal dilation of the 
pupils, and paralysis on one side of the face and body. 
In the unconsciousness of epileptic convulsions there 
is usually little trouble in deciding what is present, 
from the frothing, and biting of the tongue or lips, 
with which every one is familiar. 

Unconsciousness due to Poison may be caused 
by a poison generated within the body, an example of 
which sometimes occurs in serious kidney disease. 
c 



26 ACCIDENTS AND EMERGENCIES. 

In such cases there are usually convulsions as well 
as unconsciousness, and often a dropsical appearance 
about the eyes and legs, very profound stupor and a 
smell like urine about the person affected. 

The cause of poisoning by gases is generally easy 
to detect. The only insensibility due to drugs 
which is actually likely to be confused with intoxica- 
tion is that caused by opium. But in this the pupils 
are strongly and rigidly contracted — the very oppo- 
site of what is seen in drunkenness. 

Unconsciousness due to Intoxication is 
marked, it is true, by many signs of other insensibili- 
ties, but it has these peculiarities : the face is usually 
flushed, the body relaxed everywhere, the person capa- 
ble of being roused by loud cries, the pupils dilated 
evenly, and a distinct odor of liquor to be discovered. 

When a doubtful case arises the first thing to be 
done is to see if there is an odor of liquor to be dis- 
covered. If there is not, one may be sure he is not 
dealing with a case of intoxication. But if, on the 
other hand, the odor is present, one must not conclude 
at once that the case is one of simple drunkenness. 
For it often happens that liquor is given after an acci- 
dent, and an accident may have happened to a man 
who had been drinking. To avoid mistake : — 

i . The head must be examined. If there is a cut or a 
bruise, the only safe thing to conclude is that there 
is a brain injury, received before or after the liquor 
was taken. 



FITS OR. SEIZURES. 27 

2. The pupils of the eyes must be examined. If they 
are contracted, it is a case of brain disease or opium 
poisoning. If one is contracted and the other 
dilated, it is a case of brain injury or disease. 

3. The face miist be examined. If it is drawn and 
wrinkled on one side, and smooth on the other, it is 
a case of apoplexy, or stoppage of a blood vessel in 
the brain, or pressure upon one part of the brain. 

4. The mouth ?nust be examined. If it be frothy 
and if the tongue or the lip be bitten, it is a case of 
epilepsy or some other convulsive disorder — not 
simply intoxication. 

5. The arms and legs must be examined. If one is 
stiff and one limber, it is a one-sided paralysis, or 
hysterics. If it be the latter, the person affected will 
usually resist any attempt that may be made to open 
the eyelids \ which may be regarded as an infallible 
evidence of hysterics. At the same time close watch- 
ing will generally lead to the discovery of some sign 
that the affected person is listening to what is being 
said about him or her. 

After all these tests have been applied, there will 
still be a few cases where it will be hard to say — in 
the presence of an odor of alcoholic liquor — whether 
there is, or is not, some more serious trouble than 
mere drunkenness present. In these five cases the 
only safe course is to take it for granted that there 
is some other trouble present — even if there be in- 
toxication too — though it be at the risk of being 



28 ACCIDENTS AND EMERGENCIES. 

sometimes deceived and imposed upon. When there 
is any such doubt the person must be transported 
and treated with great care, an attempt being made 
to discover what is the disease or injury which, alone 
or combined with intoxication, has produced the 
condition in which he has been found. Such a per- 
son should never be made to walk to a station house or 
be co?iftned alone, or be permitted to escape the 
vigilance of those who take charge of him, till they 
can rest the responsibility of his fate on others 
better instructed or in authority over them. 

The treatment suitable for all cases when there is 
doubt as. to the cause of unconsciousness is to secure 
quiet and rest, the body being laid upon the back, 
with the head a little raised. If there be great 
paleness and a cold surface, with slow, sighing 
breathing — the signs of prostration — smelling salts 
or hartshorn may be held under the nose, hot tea or 
coffee given and heat applied to the body. If there 
be great heat of the surface, cold may be applied to 
the body and head and cold drinks given. 

With these general remarks on the way to decide 
between simple intoxication and other causes of loss 
of consciousness, let us now consider separately the 
way in which doubtful cases should be managed, and 
several common forms of fits or seizures. 

Fainting is too familiar to need much detail of 
symptoms. It is due to a temporary weakening or 
pause in the heart's action, causing a diminution 



FITS OR SEIZURES. 29 

or suspension of the circulation of blood in the 
brain, and a consequent loss of consciousness. This 
is accompanied with a loss of muscular power, so 
that the individual, if standing, falls. The pallor 
of fainting is very well known, and is simply a signal 
of the like bloodlessness which obtains in the brain 
itself. Usually no treatment is demanded in faint- 
ing, for a wise provision of Nature puts the person 
who faints in the best position for recovery, that is, 
lying down. But if in any way this is prevented 
from happening of itself, it should be brought about 
by a bystander. A fainting person must be laid out 
flat at once. The head must be put as low as, or 
lower than, the body, so that the heart may not 
have to work against the law of gravitation in send- 
ing blood to the brain. Sprinkling water upon the 
face and holding smelling salts to the nose tend to 
excite the nerves of sensation, and rouse the brain 
and heart to renewed activity. So they are useful. 
Nothing else is usually necessary ; though if a person 
is very slow in coming to, it may be well to apply 
heat to the pit of the stomach. But of all, the first, 
the indispensable thing, is to lay the fainting person 
down flat. Nothing should be allowed to interfere 
with this. 

Hysterics — not hysteria, for that is usually a tedious 
and inscrutable nervous disease — but fits of hysterics, 
marked by prolonged and uncontrollable laughing or 
crying, are best treated by the exercise of calmness 



30 ACCIDENTS AND EMERGENCIES. 

and patience on the part of the bystanders, some- 
times by taking no notice of the attack, or by leav- 
ing the unfortunate sufferer in a room by herself or 
himself — for men are at times subject to this curious 
disorder. Heroic measures, like dashing water into 
the face, are not to be generally recommended. 
Good is sometimes done by giving valerian or Hoff- 
man's anodyne, if it can be gotten. 

In Epileptic Fits the sufferer usually has a warn- 
ing sensation, and often starts up to leave the place 
he is in. There is in the attack a pallor of the face, 
a peculiar cry, a loss of consciousness, a moment of 
rigidity, and then the face becomes congested and vio- 
lent convulsions come on. In these there is usually 
some foaming at the mouth, the eyes roll or are 
turned up, and often the tongue or lips are bitten. 

Epileptic fits are to be treated very much like 
fainting fits, because in them also the brain is tempo- 
rarily bloodless. At the same time any movements 
calculated to injure the person must be controlled. 
There is no use in struggling against such as will do 
no injury ; they had better be simply regulated, and 
no attempt made to entirely prevent them ; but a 
folded towel or a piece of soft wood may be — if it 
can be — thrust between the teeth, to prevent the 
usual biting of the tongue. When the height of the 
convulsion is passed, rest, quiet, and perhaps a 
moderate stimulation may be secured. Here again 
the flat position of the body must be obtained. 



FITS OR SEIZURES. 31 

I remember, one summer, at the seashore, to have 
seen some ill-advised, though kind-hearted, persons 
walking a boy up and down the beach during an 
epileptic attack, because, from his pallid face, they 
thought he was suffering from the cold ; and they 
were much astonished at the rapidity with which he 
regained consciousness when laid out flat on the sand. 

It would be a good plan if every one who is sub- 
ject to epileptic attacks had his or her name and 
address placed just inside the coat, or in some place 
where it could be seen at once when the clothing is 
loosened to give relief, as is almost invariably done 
when such attacks occur. Epileptics should not, 
except when it is absolutely unavoidable, go about 
alone, or go into crowded places. They have no 
right, on their own account and for the sake of others, 
to incur the risks involved in such conduct, except 
under the stress of necessity. 

Convulsions of Children and Infants are 
generally (in the absence of brain disease) due to 
some irritation of the digestive apparatus or to 
teething. They are usually preceded by some other 
evidence of irritation, such as restlessness and fretful- 
ness. When they come on, there is a loss of con- 
sciousness and spasms. These may affect the whole 
body at once, or only a half, or only one limb at a 
time. The eyeballs sometimes roll about, or they 
squint, or they are turned far up so that only the 
lower part of them can be seen. 



32 ACCIDENTS AND EMERGENCIES. 

When convulsions occur, the child should have 
cold applied to the head and heat to the body. It 
often seems to do good to plunge it into a tub of hot 
water to which some mustard has been added. 

A large injection of hot soap suds should also be 
given, to clear the bowels out, and if an emetic can 
be given it may be done, in the hope of removing 
some cause of trouble from the stomach. 

Apoplexy consists of the rupture of a blood 
vessel in the brain, and is marked by a slow pulse, a 
greater or less, sudden loss of consciousness, stupor, 
heavy, snoring breathing, and usually a deeply flushed 
face. The pupils are generally dilated. Paralysis 
may be observed at once, or it may follow. Usually 
it is limited to one side, and may be detected by 
observing that one side of the face is drawn up, 
while the other looks flabby, and the corner of the 
mouth on that side hangs down a little. 

For this condition, rest and cold to the head con- 
stitute the best treatment until medical advice, which 
is indispensable, can be obtained. If this cannot be 
had for some time, the bowels should be emptied, if 
possible, with an injection of hot water and soap, 
and a purgative given by the mouth as soon as it 
can be swallowed. 

Intoxication sometimes closely resembles apo- 
plexy, and should be treated in the same way until 
its identity can be safely established. For this 
the odor of the breath is a useful guide, though it 



FITS OR SEIZURES. 33 

may be due to a stimulant, given by a bystander 
after an accident, or taken just before one. In addi- 
tion, it may be remembered that, in a case of deep 
drunkenness there is no paralysis, though there is 
helplessness equally on both sides ; that the person 
can be aroused from the stupor, and that generally 
if the eyeball be touched he will attempt to close the 
eyelids. In such a case an emetic should be given, 
and, if any hartshorn or aromatic spirits of ammonia 
is at hand, a teaspoonful of this in a teacupful of 
water. A large draught of vinegar will often go a 
great way toward sobering an intoxicated person. 
If there is much evidence of prostration, with cold, 
clammy skin, heat will have to be applied to the 
body, to prevent collapse. 

Emetics are sometimes of value in cases of profound 
intoxication, but it must be borne in mind that, if a 
mistake be made — as has been — and the trouble be 
an apoplexy, no more dangerous thing could be 
done than to give an emetic. 

Catalepsy is a very rare state, resembling death. 
It affords time enough for summoning a doctor, and 
this is the only sensible thing to do under these 
circumstances. 



34 ACCIDENTS AND EMERGENCIES. 



Injuries to the Brain. 



Concussion of the Brain, or stunning, may be 
caused by blows or falls on the head, or even by falls 
upon the feet. In such cases there is sickness, some- 
times fainting, with paleness and depression. There 
is also usually confusion of ideas, and the sufferer 
cannot talk continuously and coherently. There 
may even be unconsciousness. 

The proper treatment for this condition is to lay 
the sufferer out" flat on the back, loosen any clothing 
that binds his neck or waist, and secure quiet and 
plenty of fresh air. If the skin becomes cold and 
clammy, heat should be applied to the body and 
limbs. No whisky or brandy should be given, 
except by a doctor's order. 

Compression of the Brain. This is caused by 
the pressure of broken bone upon the brain after a 
fracture of the skull, or by the pressure of blood 
poured out in a hemorrhage inside of the skull. 
The symptoms are loss of consciousness, sometimes 
paralysis, sometimes twitching of the muscles, or 
even convulsions, and usually heavy snoring breath- 
ing, with wide dilation of one or both pupils. The 
treatment is the same as for apoplexy. (See p. 32.) 



EFFECTS OF HEAT. 35 



Effects of Heat. 



Burns or Scalds are usually dangerous in pro- 
portion to their extent and depth. Those which 
involve as much as half the surface of the skin are 
almost necessarily fatal. 

The treatment of burns may be divided under 
two heads. The first is for the moment of the acci- 
dent. When clothes are on fire the wearer must not 
run about, but lie down and be covered with a rug, 
or blanket, or carpet, or shawl, or coat — anything 
which will exclude the air and smother the flame. If, 
in fright, the sufferer lose presence of mind, some 
bystander must take the responsibility of throwing 
her (for these accidents usually happen to women, on 
account of the character of their clothing) down and 
enveloping her with some thick cover. 

After an extensive burn or scald, so much of the 
clothing as has to be removed must be clipped 
away, so as not to burst blisters that have formed. 
These may be punctured at one edge and their 
contents allowed to run out, and the elevated cuticle, 
or outer skin, to fall down upon the deeper layer. 
Then a dressing of pure sweet oil, or castor oil, is to 
be applied on strips of soft old linen, and disturbed 



36 ACCIDENTS AND EMERGENCIES. 

as little as possible afterward. It is customary in 
hospitals to clip away the clothing and .envelop the 
patient in lint soaked in " Carron oil" (which is a 
mixture of equal parts of linseed oil and lime water), 
and to administer stimulants and anodynes. In 
case of a person severely and extensively burned 
the entire body may be immersed in a bath, which 
shall be kept, as long as necessary, at a temperature 
of ioo°. When the shock of a burn is great some 
stimulant should be given, and laudanum, in twenty- 
drop doses to an adult, and half as much to a child, 
to allay the suffering. Of course, medical advice 
will be taken in such grave circumstances. 

Slight Burns or Scalds are best treated by ap- 
plying a cloth soaked in a strong solution of baking 
soda — the bicarbonate, in the proportion of a heap- 
ing tablespoonful in a teacupful of water, or it may 
be powdered on without using any water. This 
usually allays the pain more effectually than any- 
thing else that is known. Carron oil is a good 
application for such burns. So is the white of egg y 
and in an emergency damp earth might be used, or 
white lead paint. Anything may be used which will 
prevent friction and exclude the air; but nothing 
should be used which will stick in cakes and prevent 
after-examination, or make this very painful. For 
this reason flour and cotton batting, though often 
recommended, had better not be used. For small 
burns simple cold water is better in every way than 



EFFECTS OF HEAT. 37 

these. Indeed, for any but the most extensive burns 
it is one of the best remedies. An arm or a leg can 
be immersed in it and left there a long while with 
great advantage. 

Burns with acids must be deluged with water 
and then treated like other burns. 

Burns with caustic alkalies should be treated 
by an application of vinegar, followed by applica- 
tions of oil. 

Burns with hot pitch. After such burns the 
pitch often sticks. In such a case it ought not to be 
removed, but let alone. 

Sunburn, and the burns caused by external appli- 
cations, like mustard, may be treated very success- 
fully with the baking soda. This may also be mixed 
with vaseline, or cosmoline, or lard from which the 
salt has been boiled out, in equal parts, and used as 
an ointment. 

Sunstroke, or more properly Heatstroke, is not 
even usually due to the direct rays of the sun, but 
rather to a prolonged elevation of the bodily tem- 
perature, oftenest while working, and especially in 
confined places. When it takes place in the open 
air it is apt to be on oppressive, heavy, or murky 
days. It is generally preceded for some time by 
pain in the head and a sense of oppression. The 
attack, however, culminates in a loss of conscious- 
ness, with heavy, labored breathing, and an intense, 
burning, dry heat of the skin. The absence of 



38 ACCIDENTS AND EMERGENCIES. 

perspiration in the presence of so great heat is one 
of the most characteristic symptoms of heatstroke. 

When it occurs the thing to be done is to lower 
the temperature. As much of the clothing as pos- 
sible must be removed, cold must be applied to the 
head and body, and ice may be rubbed over the 
chest and placed in the armpits. 

Pouring, or dashing, cold water over the body is 
not to be advised, as it conveys a needless shock to 
the system ; but there is nothing better than to place 
the body in a cold bath, or to wrap it in sheets kept 
wet and cold by renewed applications of cold water 
or ice. After a while consciousness will return. 
Then the cold may be discontinued, and renewed 
only if the surface becomes again very hot — that is, 
hot in contrast to that of a well person, not in con- 
trast to the ice or water that has been used — or in 
case consciousness should be lost again. 

It must always be remembered that sunstroke, or 
heatstroke, is a very dangerous thing, and may be 
followed by grave and permanent impairment of the 
intellect. 

Heat exhaustion. This is a condition of great 
depression of the system due to the action of heat, 
and, occurring in hot weather, it might be confounded 
with sunstroke or heatstroke. But in heat exhaustion, 
instead of a hot, dry skin, there is a cold, moist one. 
This calls for rest, fresh air, a cool apartment ; but 
no application of cold to the surface. Small doses 



EFFECTS OF HEAT. 39 

of brandy, thoroughly diluted, may be given, and 
the system gradually brought back from its depres- 
sion. 

Lightning Stroke. This is marked by evidences 
of shock, with reduction of the force of the circula- 
tion, weak pulse and slow, sighing breathing. It 
must be treated with rest and stimulants, and warmth 
applied to the body. 



40 ACCIDENTS AND EMERGENCIES. 



Effects of Cold. 



Freezing sometimes takes place in so insidious 
a way that the sufferer is not aware of it till great 
damage has been done. Toes are perhaps oftenest 
frozen or frost-bitten. This results partly from the 
practice of wearing tight and insufficient coverings 
on the feet. When it occurs, it is best treated by 
gradually bringing the temperature up to that which 
is normal — about gS° Fahrenheit — and maintaining 
it there. Warm baths, gentle friction, and afterward 
covering with a thick, hot poultice, is the best thing 
that can be done until medical help can be obtained. 
This is important in such cases, because not infre- 
quently gangrene follows the freezing of the feet, 
making it necessary to amputate parts of them. 
Frozen fingers, ears, or noses are of less frequent 
occurrence, but must be treated on the same princi- 
ples. 

If the whole body has been exposed to extreme 
cold, there will follow a depression which requires 
the most cautious treatment. To restore its warmth 
is the first demand, and for this a warm bath, made 
gradually warmer until as hot as can be well borne, 
surrounding with heated blankets, or exposure before 



EFFECTS OF COLD. 41 

an open fire may be used.* At the same time stimu- 
lants may be given internally, such as hot tea and 
coffee, with the addition of small quantities of spirits. 

* This recommendation is contrary to popular belief and contrary to 
what is taught in most text-books. But it has been proved to be correct, 
by experiments made in Russia, where it was found that the best way 
to resuscitate dogs which had been frozen, was to put them at once into a 
hot bath. Of twenty animals treated by the " gradual " method in a cold 
room, fourteen died ; of twenty introduced at once into a warm room, eight 
died ; of twenty placed immediately in a hot bath, all recovered. 



42 ACCIDENTS AND EMERGENCIES. 



Sprains. 



Sprains of the finger or wrist usually require 
cold and moist applications. In the latter, the hand 
and forearm should be laid on a straight splint, and 
lightly secured to it with a soft bandage or broad 
strips of sticking plaster. One of these should go 
round the hand and one or two round the forearm 
above the wrist — not over it. Sprains must be 
treated by rest, and heat or cold, whichever gives 
the most comfort. 

Sprains of the ankle should never, be treated 
lightly. In them there is not infrequently a little 
fracture of the inner surface of one of the leg bones 
that form the ankle joint. This complication gives 
rise to so much trouble, and requires such skillful and 
patient treatment, that it has come to be believed 
that it is better to have a broken leg than a sprained 
ankle. The general principle, however, in the case 
of a sprained ankle is, first to put the joint at complete 
rest, then to allay inflammation, if it arises, and 
afterward to promote the absorption of inflammatory 
products. For the first, a splint and bandage are 
usually necessary; for the second, friction, kneading 
of the joint, at times careful motion of it, and the 
use of moist heat. But in few cases is it truer that 
" he who doctors himself has a fool for a patient.' ' 



DISLOCATIONS. 43 



Dislocations. 



Dislocations consist of the displacement of the 
articular or joint end of a bone. They cannot occur 
(except when the same joint has been out of place 
before) without the tearing of ligaments whose func- 
tion it is to keep the joint close. They can be 
detected by the occurrence of pain and stiffness of 
the joint. There is also deformity, which can gen- 
erally be made apparent by comparing the injured 
joint with the corresponding sound one of the other 
side. 

Dislocation of the fingers can usually be 
reduced — or put in place — by strong pulling, aided 
by a little pressure upon the parts of the bones 
nearest the joint. They must be retained in place 
with a splint and bandage, or sticking plaster. 
Dislocations of the thumb are, even for surgeons, 
sometimes almost impossible to put in place. 

Dislocation of the lower jaw may be treated 
by almost any one. This is fortunate, since it is 
a very awkward dislocation, and very trying to the 
patient. It may occur at any time and under the most 
unexpected circumstances. 

To reduce a dislocation of this sort, the sides of 
the jaw must be seized between the thumb and 
fingers of each hand, with the thumbs resting on 



44 ACCIDENTS AND EMERGENCIES. 

the teeth and the fingers below the jaw, and firm 
pressure be made, first downward and then back- 
ward. It must be remembered to cover the thumbs 
with several thicknesses of cloth, and as soon as the 
jaw starts into place, to slip them off to the outer 
side of the teeth, inside the cheeks, or the releaser 
will be rewarded by having his thumbs mashed 
between the upper and nether millstones. He must 
be quick as lightning, too, for the muscles do not 
wait, when they have been so unnaturally on the 
stretch, but bring the lower teeth against the upper 
like a hammer. 

There is still another form of dislocation of the 
jaw, in which this is just a little open and cannot be 
opened any wider or closed. The thing to do in 
such a case is to slip a strong spoon handle or table 
knife in between the teeth and pry the jaw wider 
open. This will make the bone slip back into its 
place. 

Dislocation of the shoulder, that is of the 
upper arm bone from its socket, may be reduced by 
laying the patient down, sitting alongside of and 
facing him, and placing the nearest heel (with the 
boot or shoe removed) in the arm pit of the injured 
side, and then drawing down the dislocated arm 
and dragging it over toward the sound side. This 
will usually pry the head of the bone outward and 
upward into its place. If it does not succeed readily, 
the amateur surgeon had better let it alone. If it 



DISLOCATIONS. 45 

does succeed, the bone will go in with a snap. The 
arm should then be bound to the side, with the fore- 
arm carried across the chest and the hand placed on 
the opposite shoulder. 

Dislocations of other joints ought not to be 
tampered with at all. The best that can be done is 
to put the parts in the position easiest to the suf- 
ferer, surround the joint with cold, wet cloths, to 
which laudanum has been added, and send for a 
surgeon. The risk of doing injury by injudicious 
efforts to set a joint is greater than that of waiting 
till a surgeon can be summoned. 



46 ACCIDENTS AND EMERGENCIES. 



Fractures — Broken Bones. 



Broken bones may be recognized by the occur- 
rence of pain, by deformity, by bending when they 
ought not to bend, by a sound and feeling of grating 
at the point of fracture. There are two important 
divisions of fractures. Simple fractures, where there 
is no other injury besides the break, and compound 
fractures, where the bone cuts through the skin and 
there is an opening from the exterior to the seat of 
fracture. The latter are far more serious and danger- 
ous than the former. 

Broken bones call for treatment as various as they 
themselves are. Most of them require special appli- 
ances, known only to surgeons, and no attempt 
should be made by any one who has not surgical 
training to do more than treat a fracture tempor- 
arily. However, until a surgeon can be gotten, the 
following suggestions may be adopted, as far as the 
circumstances will permit. 

Fracture of the upper arm. In this the elbow 
should be drawn down and placed against* the side 
of the chest, with a layer of cloth between. Then 
the whole upper arm should be bound securely to the 
body and the hand carried in a sling raised a little 
higher than the elbow. 



FRACTURES — BROKEN BONES. 47 

Fracture of the forearm. In this the arm 
should be bent at the elbow, and placed in as nearly 
a natural position as possible, with the thumb upper- 
most. Then a broad, well-padded splint should be 
placed along the back of the forearm and hand, 
going all the way to the tips of the fingers, and 
another along the front. These should be bound on 
pretty firmly, and the hand carried in a sling and 
raised a little higher than the elbow. 

Fracture of the finger. A broken finger 
should be straightened out and bound to a light 
splint reaching from the wrist to the tip of the 
finger. 

Fracture of the thigh bone. In this fracture 
the thigh must be bent up toward the abdomen and 
the lower leg back toward the thigh, so as to relax 
all the muscles. Then one splint can be applied to 
the outer side of the thigh and one to the inner, 
and bound to it. The sufferer should then have 
both legs tied together, and lie on a firm bed, in 
this z shaped position, with the broken limb upper- 
most. 

Fracture of the kneepan. In this the whole 
leg must be bound to a straight splint placed at the 
back of the limb and going from the hip to the heel. 
A folded towel, or other small pad, should be placed 
in the hollow at the bend of the knee, so that the leg 
may not be held absolutely straight — which position 
soon becomes very painful. 



48 ACCIDENTS AND EMERGENCIES. 

Fracture of the leg below the knee. In this 
the leg should be drawn down and placed in a 
natural position, using the sound leg for comparison. 
Then a pillow should be placed under it. Under this 
broad bandages should be passed and tied together 
over the limb, so as to draw the sides of the pillow 
pretty firmly up against it. (See Fig. 3.) 



Fig. 3. 

In fracture near or at a joint it is best to bend 
the joint a little, and lay the limb flat on a pillow, 
keeping it cool and moist. These breaks are espe- 
cially grave, and demand the best skill that can be 
obtained. 

Fracture of bones that lie deep in the body, 
like the hip bone or the shoulder blade, are very 
hard to detect, and can be treated only by placing 
the sufferer in a comfortable position and securing 
rest and coolness till a surgeon comes. 

Fractures of the ribs must be treated in the 
same way. It is a good plan, however, to put on the 



FRACTURES — BROKEN BONES. 



49 




Fig. 4. 



side of the chest, where the break is, long strips of 

sticking plaster, about an inch and a half wide, 

placed parallel to the ribs, 

beginning at the lowest part 

of the chest and going up, 

each strip being made to 

overlap the one below about 

half its width. The strips 

should extend from the spinal 

column to the middle of the 

breast bone. This makes the 

chest wall more rigid and 

prevents the rubbing together of the broken ends 

of the bone. (See Fig. 4.) 
In fracture of the collar-bone the patient 

should be laid on his back, on a hard, flat, hair 

mattress, or on a settee, with a folded blanket 
under him (never on feath- 
ers), without any pillow, 
and kept so until the sur- 
geon comes. This is one of 
the best ways to treat a 
broken collar-bone until it is 
quite healed. 

In fracture of the jaw, 

close the mouth and put a 

bandage round, so as to keep 

the two rows of teeth against 

Fig. 5. each other. (See Fig. 5.) 




50 ACCIDENTS AND EMERGENCIES. 

In fracture of the skull there, is nothing the 
non-medical can do better than putting the patient 
at rest, lying down, and placing cold, wet cloths to 
the head. 

Fractures of the spinal column (broken back) 
are very hard to detect, but if one be suspected the 
patient must be moved as little as possible. He had 
best be laid out upon his back, and, if possible, not 
be disturbed till the surgeon directs it. Turning 
such a patient over upon his face is dangerous, and 
must not be permitted. 

Compound fractures, as has been remarked, 
are those in which there is an open wound commu- 
nicating with the broken ends of the bone. They 
are to be treated, in an emergency, like simple frac- 
tures in the same locations, with the additional 
precaution that they must be thoroughly cleansed 
and kept clean, and the greatest care exercised to 
keep the sharp edges of the bone from doing any 
further damage. 

In all fractures cold water should be applied to 
the surface, so as to prevent, as far as possible, the 
swelling which usually comes on soon after a frac- 
ture, and which often interferes very much with the 
examination of the surgeon. 

There is nothing in which there is a greater call 
for ingenuity and fertility of resource than in extem- 
porizing splints for broken bones. Pasteboard, 
leather, shingles, pieces of cigar box — anything 



FRACTURES — BROKEN BONES. 51 

fairly smooth and stiff, may be used. A surgeon at 
the seashore got himself no little credit once by 
setting a broken arm on the beach, folding up and 
using as a splint a large newspaper which he had 
been reading. When a leg is broken, the other one 
will make a good temporary splint, or a coat-sleeve, 
stuffed with grass or hay, may prove serviceable. 



52 ACCIDENTS AND EMERGENCIES. 



Wounds. 



In studying wounds we will adopt the classifica- 
tion customary in works on surgery, viz., contusions, 
contused, lacerated, punctured, poisoned, incised 
and gunshot wounds. 

Contusions are what are usually known as bruises, 
and almost all wounds of the soft tissues caused 
by blows. They are sometimes very painful, and 
often followed by discoloration, due to the escape 
of blood under the skin from the small vessels of a 
part. A black eye is a familiar example of this sort 
of an injury. 

They are sometimes very simple, as in the illus- 
tration just given. Such contusions are best treated 
at first, when painful, by the application of cold, 
wet cloths. Pure laudanum is often a very accept- 
able application. Later, when the pain has subsided, 
hot, wet cloths are best, as they favor the carrying 
off of the blood that has escaped. 

Contusions of the chest or abdomen may be 
very serious, for beside the external bruises, important 
internal organs may be injured. Evidence of this 
may be seen in spitting of blood or vomiting it, or 
passing it from the bowels or from the bladder ; or 



WOUNDS. 53 

there may be great depression. In such cases little 
can be done by the non-professional person beyond 
securing complete rest and sustaining the strength 
of the sufferer by means of warmth applied externally 
and careful stimulation internally, as described in 
speaking of Shock — to which reference may be made. 

Contused Wounds. These are cuts or tears 
accompanied with bruising of the tissues. They are 
to be treated like lacerated wounds. Unless they 
bleed freely warm applications are better suited to 
such wounds than are cold ones. 

Incised wounds, or clean cuts, if simple and 
small, call only for a piece of sticking plaster, and per- 
haps a bandage. If large, the edges should be brought 
as near together as possible, and supported so by stick- 
ing plaster, or bandages, or the hands, till the com- 
ing of the surgeon. If an entire part be cut off, as 
an ear, or a nose, or a toe, or a finger, it should be 
cleaned with lukewarm water, and put in its place, 
leaving to the surgeon the decision whether it be 
worth while to try to save it. Some very remark- 
able cases of reunion of such parts are on record, 
and an attempt to save them is not to be lightly 
rejected. 

Cuts of the walls of the abdomen are often 
followed by escape of a portion of the bowels. These, 
if dirty, should be cleansed, and a gentle effort made 
to restore them to their place. If this fails they 
should be covered with a clean white cloth, soaked 



54 ACCIDENTS AND EMERGENCIES. 

in warm water and kept warm and wet by a gentle 
stream of water, or by laying on it a sponge soaked 
in warm water, which should be constantly renewed. 

Cuts of the chest wall may be followed by 
escape of a portion of lung. This should be treated 
in the way just described for escaped bowel. 

Cut throat wounds usually require, in addition 
to the ordinary treatment of the wound, that the 
head shall be bent forward, with the chin close to the 
breast bone, and kept there. 

The way to wash delicate structures, such 
as the intestines, or raw cut or torn surfaces, may 
be described here — and it is a good plan to learn 
to do such things by practicing them before the 
emergency arises. Dip a sponge in water, and hold 
it in the closed hand, with the thumb uppermost, 
and a corner of the sponge hanging below the 
fist. Now, on squeezing it regularly, a single stream 
of water will flow softly and steadily down from it. 
The size of this stream can be regulated by the way 
the sponge is squeezed, the force by the height to 
which it is raised. This is the only way of cleaning 
off delicate tissues that is safe in the hands of the 
unexpert. 

Lacerated wounds are tears with ragged edges, 
such as are often caused by machinery, bricks, clubs, 
timbers, stones, dull tools, glass, hooks, etc. These 
always require surgical skill. Till it can be obtained, 
however, the torn parts can be placed in as nearly 



WOUNDS. 55 

their natural position as possible (after removing, 
with a stream of lukewarm water, squeezed from a 
sponge, any foreign matters that can be so gotten 
rid of) and covered with a cool, wet cloth, or a 
cloth soaked in laudanum, or alcohol. If the tear 
has been very great, and the sufferer is depressed and 
cold, tablespoonful doses of brandy or whisky may 
be administered, and a cloth wrung out of hot water 
placed over the injured parts. 

Punctured wounds are made with sharp-pointed 
objects, like arrows, pins, needles, tacks, fish-hooks, 
glass, thorns or splinters. Of these 

Pin wounds rarely do much harm. 

If a needle is run into the flesh and comes out, 
always see that it is all there ; and if any part, from 
point to eye, is missing, call a surgeon. Meanwhile 
keep the wounded part perfectly still, and make no 
attempt to remove what remains. This would pro- 
bably be quite in vain, and would only increase the 
difficulty of the surgeon's work when he arrives. 
The broken needle should be carefully kept and 
shown to him, as he will then know better what to 
look for in his examination. 

A fish hook is a troublesome thing to get in one. 
If this should happen, the best thing to do is to cut 
off the string, push the point of the hook through, 
and draw it out, like a needle in sewing. If it can 
be done, the broad part of the hook may be cut off 
before trying this. But this is not easy for the 
operator or the patient. 



56 ACCIDENTS AND EMERGENCIES. 

Thorns rarely do much harm unless they are 
poisonous, and wounds of this sort we shall consider 
later. 

Splinters are dangerous in proportion to their 
size and the part they enter. Small splinters may 
be picked out with a needle. 

Splinters under the nails sometimes defy at- 
tempts at removal by the non-medical. But the way 
to succeed is to scrape the nail as thin as possible 
over the splinter, then split it or cut a little tongue 
out and remove the splinter. Often when, after this, 
the splinter cannot be removed, it will yet come 
away of itself when matter forms ; and in any case 
the sufferer will be much better off for submitting 
to this little operation. 

Splinters of glass are quite beyond most 
people's skill. They are best treated with cold, 
wet applications, and left otherwise entirely to the 
surgeon. 

Splinters in the eye should be pulled out, if 
possible. If not, the eyelid had better be gently 
closed, both eyes covered with a layer of cotton 
soaked in cold water, and a bandage placed round 
the head, so as to keep the lids as still as possible. 
This bandage should not be too thick or put on 
too tight, and the application should be kept cold, 
with ice, if need be. 

If a large splinter enters the body, an attempt 
may be made to pull it out ; but a surgeon should 



WOUNDS. 57 

be called without fail, and whatever of the splinter 
has been extracted carefully saved and shown to him. 
This will aid him in making up his mind whether 
the removal has been complete, an'd perhaps save 
much pain and danger to the patient. 

Poisoned wounds may be considered here, as 
they are usually punctured, and result from the bites 
or stings of animals or insects. 

The bites of venomous serpents usually 
demand the prompt removal of the part bitten. It 
may be cut out instantly by any one who has the 
nerve to do it. Before this, perhaps, the part should 
be encircled, above the wound, with a tight ligature, 
and, if small enough, thrust into the mouth and 
sucked hard, so as to extract the poison. The imme- 
diate application to the wound of hartshorn is of 
advantage ; and a knitting-needle, or nail, heated 
to redness, may be thrust into it. At the same time, 
whisky should be given, in doses large enough to 
cause drunkenness, and the intoxication kept up till 
medical aid can be secured. 

The stings of tarantulas, scorpions, centi- 
pedes, etc., are to be treated with cold, and harts- 
horn applied to the point where the sting entered. 

The stings of insects are rarely dangerous to 
life. They may be treated with cold, wet applica- 
tions — wet earth is a very good one. The applica- 
tion of a drop of hartshorn or wet salt often gives 
great relief. 

E 



58 ACCIDENTS AND EMERGENCIES. 

The bites of cats and rats are sometimes fol- 
lowed by severe inflammation ; but the first treat- 
ment should be simply cleansing the bites, sucking 
them, perhaps,* and applying cold to' them for a 
time. 

The bites of dogs are a terror to many people, 
while others have little fear and are very seldom 
bitten. Dogs seem to learn who do not fear them. 
If any one be bitten by a dog in good health, only 
the simplest treatment will be necessary. If the dog 
be sick, local inflammation, or severe constitutional 
disturbance may follow. In case of reasonable sus- 
picion, the same course should be adopted as for 
bites of venomous snakes. Of course, too, sound 
medical advice will be taken. 

It is a foolish thing to kill a dog that has bitten 
anybody, soon after this has taken place. Such a 
dog should be caught and kept under the observa- 
tion of some person of unquestioned carefulness, 
intelligence and special information. The too 
speedy slaughter of a dog has robbed many a sufferer 
of the assurance that would have been gained by 
seeing it living and well, and sent many a one to the 
grave, as dying of hydrophobia, who never had it, 
but had been bitten by a healthy and harmless 
animal. 

Again, if one has been bitten, and there be a rea- 
sonable suspicion that the dog was " mad," let him 
not despair. Some of the most able and careful 



WOUNDS. 59 

(that is the greatest matter) medical men are of the 
opinion that a great many cases of so-called hydro- 
phobia have been spurious ; that is, they were not 
hydrophobia at all. For myself, the more I have 
studied this subject the more convinced have I 
become that very few of the cases reported have 
really had hydrophobia; but that the most have 
been alarmed by what they thought, and frightened 
by what injudicious friends or timid doctors have 
said and done, until they died of sheer terror. So, 
in case of a bite from a supposed mad dog, let the 
things suggested above be done ; then let quiet be 
secured, and the very best medical man in the place 
sent for. It is a very serious matter, and calls for 
the clearest head and most extensive information. 
Whoever gets flurried and shows alarm at such times 
is scarcely less dangerous than the dog that did the 
biting. Then let no one breathe " hydrophobia/ ' 
or talk about what has happened. By this the 
chances of escape will be increased. 

This much is said, not to ventilate a theory, but 
with the belief that acting upon it will not increase 
the number of bites, while it may decrease the 
number of deaths from what is called " hydro- 
phobia." 

Gunshot wounds. This is another class of 
injuries occasionally met in civil life, though not 
common. Ordinarily little can be done for them, 
except by a surgeon ; and perhaps all that is advisable 



60 ACCIDENTS AND EMERGENCIES. 

before he comes is to note and remember the posi- 
tion of the body or the wounded part at the moment 
it was struck, and the direction from which the 
missile came, so that these facts may help the surgeon 
in his search for it.* Then cold wet cloths, upon 
which laudanum may be poured, should be kept 
upon the wound, to prevent, as far as possible, 
inflammatory swelling; and if, as is very often 
the case, the patient be in what surgeons call a state 
of shock — that is, cold and depressed — stimulating 
doses of wine, whisky or brandy should be given, 
and heat applied to the surface of the body. If a 
part is badly shattered, the local treatment should 
be the same, except that, if there be much de- 
pression, cold had better not be used at all. 
There is rarely much bleeding from gunshot wounds, 
except when large vessels are divided. In such a 
case the bleeding may be controlled as described 
under the head of hemorrhage. 

* To show how strange may be the course of a bullet, I will cite a case 
that I treated in 1876. A young man was shot with a pistol. The ball 
passed through his lower lip, struck an upper front tooth, which it broke off, 
then glanced downward and backward, diagonally through the tongue, 
and finally buried itself in the floor of the mouth, on the other side from 
that where it entered the lip. 



RAILROAD AND MACHINERY ACCIDENTS. 61 



Railroad and Machinery Acci- 
dents. 



Railroad and machinery accidents may be 
the occasion of simple incised, contused or lacerated 
wounds, or, as is very common, of severe tears, 
wrenching off of fingers or toes or limbs, or of 
crushes. Saws, planing machines, cog-wheels, belts, 
and many other machines or parts of machines, 
cut or tear off many a limb or part of one. Such 
injuries almost always occur when no medical aid 
can be obtained for some time, and it would be 
well if some one on every train and in every room 
or place where machinery is in motion could have 
some idea of what can be done, and what cannot, 
before a doctor can be had. 

Trifling injuries, whether cuts or tears, are to 
be treated on the principles already described in 
speaking of incised or lacerated wounds : that is, 
the parts are to be cleaned as gently and as well as 
possible, by letting lukewarm water run over them. 
Then, any displaced tissue — skin or flesh — may be 
put in place, and a clean, white cloth, soaked in 
laudanum or alcohol or water, laid upon the wound, 



62 ACCIDENTS AND EMERGENCIES. 

and bound on loosely with an extemporized band- 
age. 

Hemorrhage is not usually severe after railroad 
and machinery accidents, because the wounds are 
generally inflicted in a way which closes up the 
blood vessels as they are torn or twisted off. 

Large tears, or lacerations, must be treated 
by carefully removing any fragments of clothing, or 
dirt or splinters of any sort, and washing with luke- 
warm water. For removing foreign matters, the best 
forceps are in everybody's possession. They are a 
finger and thumb ; and no one need be afraid to 
use them with reasonable care. They may be aided 
occasionally by touches with a clean linen or muslin 
cloth, or a clean sponge; but these must be un- 
doubtedly clean. 

After cleansing is complete, the torn parts must 
be put in position, and kept so by bandages, sticking 
plaster, or the hands of another person, as may 
seem best. Sometimes a splint is required. This is 
usually easy to prepare in a mill or on a railroad. 
It may be clumsy — that is not of much consequence 
— but it ought to be sufficiently large to keep not 
only the injured part still, but, in case of a limb, the 
joint above and the joint below the injury. 

Such injuries are often accompanied with com- 
paratively little pain. If, however, there should be 
severe pain, laudanum may be given — about thirty 
drops to an adult. Cold or hot cloths — whichever 



RAILROAD AND MACHINERY ACCIDENTS. 63 

are most comforting — must be applied to the 
injury. 

When fingers or toes are crushed they ought 
to be washed, modeled into good shape, dressed with 
a piece of soft white cloth, wrung out of hot or cold 
water, and laid upon a small splint. 

If a finger or toe hangs by a mere shred, snip it 
off entirely. Because, although such fingers and 
toes have been saved, such a result is almost miracu- 
lous, and the cost, in time and trouble and money, 
is more than a finger is worth to a workingman, and 
indeed to almost anybody. 

When fingers or toes are torn off the stumps 
almost invariably require a scientific amputation. 
But, until this can be decided upon, they must be 
cleansed, and treated with a cool, wet application of 
some sort, and then not meddled with. 

Hands or feet that have been crushed must 
be treated by being wrapped up in some soft warm 
dressing, like cloth, or cotton, or wool. Cold is 
only to be used if there be profuse bleeding. The 
injured part must invariably be supported with some 
sort of a splint and placed about on a level with the 
body. One who has received such an injury ought 
to be made to lie down, unless some other course is 
absolutely necessary for moving him, or is authorized 
by a surgeon. Such injuries rarely cause much pain, 
but they almost invariably cause great depression. 
This must be met by keeping the sufferer warm with 



64 ACCIDENTS AND EMERGENCIES. 

wraps and hot cans or bricks, or bottles, and giving 
him, every few minutes, a small quantity of whisky 
or brandy (a teaspoonful) in a little hot water. 
Larger doses of spirits are not needed. (See Shock.) 

When hands or feet have been torn off or 
cut off with wheels, the stumps are to be treated as 
described, and the limb placed in such a position 
that the injured point is higher than any other. 
These injuries are usually accompanied with depres- 
sion also, and this is to be combated in the manner 
just described. 

Crush of the arms or legs is to be treated like 
crush of the hands or feet. But here the prostra- 
tion is usually much greater and the need for sup- 
port, with warmth and stimulants, more urgent. 
The clothing should on no account be disturbed, 
except in so far as it can be cut away and replaced 
with warm coverings. 

Crushes of the chest are sometimes instantly 
fatal, and almost always cause death in a short time. 
In such cases, as well as in case of 

Crushes of the lower part of the body, there 
is nothing that can be done beside securing rest, 
warmth and moderate stimulation. The sufferer 
should be made as comfortable as possible, and 
prepared for the almost inevitable issue. 

Shock is a condition which has been alluded 
to already, in speaking of certain injuries. It may 
also be caused by fright, as, for example, that which 



RAILROAD AND MACHINERY ACCIDENTS. 65 

may accompany a trifling gunshot wound. Or it 
may be caused by a blow upon the pit of the stomach, 
or by a sudden and severe pain, or even by drinking 
a large quantity of ice-cold water. It is very com- 
mon after gunshot wounds, and almost invariable 
after serious railroad or machinery or mining acci- 
dents. 

The signs of shock are : great paleness, a cold, 
clammy skin, a Very feeble pulse and feeble breath- 
ing, a pinched face, dull eyes, drooping eyelids, 
dilated pupils, bewilderment or dullness of mind, or 
even insensibility. A person in such a state may 
die very soon, and will surely die before long, unless 
he can be brought out of the shock. This requires 
prompt, energetic and persistent effort on the part 
of those who come to his assistance. Heat must be 
applied, if possible, to the whole body, and espe- 
cially to the region of the heart and pit of the 
stomach. This can be done with a hot bath, a hot* 
fire, hot cans, hot bottles, stove plates, heated 
blankets — in fact, anything hot that can be got hold 
of. At the same time hot drinks, to which brandy 
or whisky has been added, may be given in small 
and frequently repeated quantities. To be more 
exact, a teaspoonful of brandy or whisky in a table- 
spoonful of hot water may be given every ten minutes 
for several hours. 

Manufactories, mines and railways ought to be 
furnished with appliances for the treatment of this 



66 ACCIDENTS AND EMERGENCIES. 

condition and some one who knows how to use 
them; for shock almost always follows severe acci- 
dents occurring to their employees, and is the most 
common cause of death after them, as any hospital 
surgeon could testify. 



HEMORRHAGE — BLEEDING. 67 



H emorrhage— Bleeding. 

There is no accident so appalling as hemorrhage, 
whether the bleeding comes from an external wound 
or from the rupture of blood vessels in some internal 
organ. There is none which calls for so much nerve 
in combating it, nor any in which a little accurate 
knowledge can be more valuable. 

The subject of the control of hemorrhage will be 
better understood after taking a concise view of the 
anatomy of the organs of circulation. This cannot 
be made absolutely accurate without being too 
technical, but the variations from accuracy will not 
affect its practical utility. (See Frontispiece.) 

The blood starts from the left side of the heart, 
and is driven first into the aorta, which curves over 
above the heart and descends along the left side of 
the spinal column, within the chest and abdomen. 
From what is called the arch, at the beginning, are 
given off the vessels which supply the head and arms. 
The former (the carotid arteries) run up alongside 
the windpipe and divide and subdivide in all direc- 
tions. The latter curve forward and come out from 
the chest over the first rib, and, passing under the 
collar bone near the shoulder, run down through 



68 ACCIDENTS AND EMERGENCIES. 

the armpit and inside of the arm to the middle of 
the front of the elbow, and here divide into two 
branches. One of these passes along the front of the 
forearm, on the thumb side, and the other along the 
little ringer side. Thus, in the upper arm the arteries 
follow nearly the same line as the seam in a coat- 
sleeve. The two arteries of the forearm, entering 
the palm of the hand, join in a loop, from which 
vessels run down, one on each side of each finger, 
and one on the inner face of the thumb. 

The aorta, as it descends through the chest and 
abdomen, gives off vessels to supply the internal 
organs, and near the lower end of the backbone 
divides and sends two large vessels out through the 
groin into the thigh. Each of these runs down in 
almost a straight line, between the muscles, to 
the middle of the hollow at the back of the knee. 
Just below this it divides into three branches. The 
first of these passes through to the front, between the 
two bones of the lower leg, and runs down under the 
muscle, close to the outer side of the shin bone, and 
passes out upon the instep at about the middle of the 
front of the ankle joint. Here it breaks up into 
smaller vessels that supply the top of the foot. 

The second and third branches of the main artery 
of the thigh pass down the back of the lower leg, one 
on each side, close to the corresponding bone, and 
deep under the muscles. One passes back of the 
inner ankle bone into the inner side and sole of the 



HEMORRHAGE — BLEEDING. 69 

foot. The other passes back of the outer ankle 
bone, to the outer side and sole of the foot. The 
arteries of the sole of the foot, like those of the palm 
of the hand, unite to form a loop, from which a 
vessel is given off for each side of each toe. 

This is a brief outline of the course of the arteries. 
As they divide and subdivide, like the branches of a 
tree, they become correspondingly smaller, and they 
end in an inexpressibly fine network of minute ves- 
sels. These are called capillaries. Then, as the capil- 
laries are a sort of splitting up of the smallest arteries, 
so, on the other hand, by the confluence of a number 
of capillaries, larger trunks result, toward which the 
current of blood constantly sets, and the beginnings 
of the veins are formed. These unite in a manner 
the very reverse of the branching of the arteries, and, 
growing, like rivers, larger and larger by repeated 
junctions of several into, one, travel back to the 
heart in an opposite direction to, but alongside of, 
the arteries. Thus each principal artery has at its 
side at least one important vein. Up the legs, up the 
inside of the abdomen and chest, up the arms and 
down the neck they pass, till they unite to form 
one trunk, which empties into the right side of the 
heart. 

From this point the blood is pumped into the 
lungs to be aerated ; from the lungs it is collected 
and emptied into the left side of the heart ; and 
from the left side, as we have seen, it is pumped 



70 ACCIDENTS AND EMERGENCIES. 

out to begin the circuit through which we have just 
traced it. 

The diagram in the frontispiece will give a fair 
idea of the course of the main blood vessels, and 
will make clearer what may not have been under- 
stood from the preceding description. 

It will be observed that the course of the blood 
vessels is always in the safest part of the body or 
limb. They all lie where they are protected by 
bending a limb or a joint — a natural act when 
attacked. They are on the inner side of the arm 
and forearm, when these are used for attack or 
defence. They are on the inner side of the thigh 
and at the back part of the leg — out of harm's way. 
In endeavoring, as shall hereafter be recommended, 
to check bleeding by pressing upon a main blood 
vessel, this fact may serve as a reminder of the 
course it might be expected to run. To which this 
suggestion may be added, namely: When you are 
in doubt, feel for the pulsation of the artery and 
make pressure where you feel it beating. Another 
point, preliminary to considering the methods of 
arresting hemorrhage, is that blood from arteries is 
usually bright red and escapes in jets, while blood 
from veins is dark red or purple, and flows in a 
steady stream. Blood from capillaries is of a color 
between these two, and it oozes out. 

Capillary hemorrhage follows every cut. The 
color of the blood is red ; the flow is generally slow 



HEMORRHAGE BLEEDING. 71 

and not very considerable. It usually stops of itself. 
If it does not, the part may be elevated and cold 
water or ice or snow, or even vinegar, applied. If 
there is oozing from a large raw surface, a towel 
may be folded, dipped in water as hot as the hand 
can bear, lightly squeezed, so as not to drip, and 
laid upon the bleeding surface. This may have to 
be renewed once . or twice, at intervals of a few 
minutes, but it usually acts like magic in this form 
of hemorrhage. 

Hemorrhage from the veins is also generally 
slow and steady in its flow, the blood being of a 
darker color than in other forms. It, too, is rarely 
of consequence or demanding special effort to con- 
trol it. When severe, the application of cold, and 
firm continuous pressure upon and below the wound, 
generally suffice to stop it. Rupture of varicose veins 
in the leg may lead to dangerous hemorrhage, but 
this can usually be checked by applying a dry pad 
of cloth and binding it firmly down upon the bleed- 
ing spot. 

A wound of the jugular vein, on the side of the 
neck, may also be followed by dangerous hemor- 
rhage. This is also to be treated with a pad and 
pressure, which can be best made with a finger laid 
above and one below the wound. 

Hemorrhage from the arteries is very danger- 
ous. Here the blood is bright red, and spurts in a 
stream or leaps in jets from the divided vessel. If 



72 ACCIDENTS AND EMERGENCIES. 

it be from a large artery, such as lie in the root of 
the neck or the armpit, or the inside of the thigh 
near the groin, life will usually be quickly lost. 
Indeed, without a thorough acquaintance with 
* anatomy, it is hardly likely that any advice that 
could be given here would be available in such cases. 
The only thing to suggest is to thrust a finger deep 
into the wound and see if firm pressure there will 
stop the bleeding. Or some other form of plug may 
be tried. The chances of success are, however, 
very slight. 

But every one may, while awaiting skilled aid, 
do something when the arteries of the limbs are cut. 
The first duty in all such cases is to be cool as pos- 
sible, then, as quick as is consistent with coolness. 
The principle that must guide every attempt to stop 
the bleeding is to obstruct the artery at the spot, or 
between the centre of the body and where it is 
cut; for this is the direction in which the blood 
flows. 

For wounds high up in the arm, strong pres- 
sure may be made downward, behind the collar 
bone, about at its middle (see Fig. 7.) The thumb, 
or the handle of a large door key, well wrapped, so 
as to make a tolerably thick mass, can be thrust 
down, and if it does not seem to strike the artery the 
first time, it can be moved along, toward the breast 
bone and toward the shoulder, to see if it will hit 
the right place. 



HEMORRHAGE BLEEDING. 73 

For wounds of arteries of the finger, pres- 
sure may be made on the side, by seizing it between 
the thumb and finger and pinching it, or by wrap- 
ping a cord round, or slipping on a rubber band. 

For wounds of arteries of the hand, raising 
this above the head and making firm pressure on the 
bleeding spot, or with both thumbs just above and in 
front of the wrist, will usually stop the bleeding. Or 
the wound may be packed with lint, or cotton, or 
old muslin, or linen, and bound firmly with a ban- 
dage. If this fail, resort must be had to the 
measures recommended for the next form of hem- 
orrhage. 

For wounds below the elbow, first grasp the 
upper part of the arm with both hands and squeeze 
as hard as possible ; then let some one make a thick, 
hard knot, as big as an Ggg f in the middle of a hand- 
kerchief, place it over the 
middle of the front of the 
arm, immediately above 
the elbow, tie the ends 
tight at the back, and bend 
the forearm up so as to 
press hard against the knot 
(Fig. 6). This, if success- 
fully done, will obstruct 
the main blood vessel (the Fig. 6. 

brachial artery), which in this place lies in the 
middle line of the bend of the elbow. 




74 



ACCIDENTS AND EMERGENCIES. 



For 'wounds in the upper arm, pressure may- 
be made against the bone on the inner side and just 

below the swelling 
muscle, which most 
people are aware is 
called the biceps, as 
shown in Fig. 7. A 
knot as big as a fist 
may be made in any 
piece of cloth and 
shoved hard up into 
the armpit, and the 
elbow then brought 
straight down and 
held or bound firmly 
against the side of 
the chest. 

If either of these 
Fig. 7. methods fail, or can- 

not be carried out, the " Spanish- windlass " may be 
used. To do this, place some hard, round body, like 
a stone, in the large part of a handkerchief folded 
diagonally, and carry the ends of this round the 
limb, so as to leave the lump over the position of the 
artery — that is, over the bend of the elbow, or a 
little in front of the middle of the inside of the arm, 
near the shoulder. Then tie the ends of the handker- 
chief so as to make a loose loop, slip a stick through 
this and twist it round and round, so as to tighten 




HEMORRHAGE — BLEEDING. 



75 



the handkerchief, till the blood stops flowing. This 
is a much rougher procedure than the method de- 
scribed before, but one cannot be over-particular in 
such cases ; so if the former fails, or no bystander is 
cool enough to carry it out, no time must be lost 
before the " Spanish-windlass 7 ' is used. 

Wounds of arteries of the foot or leg may 
be treated by firm pressure in the hollow just behind 
the knee (above the calf of the leg). This can be 
effected by placing there a 
knotted cloth, like that sug- 
gested for the armpit, and 
doubling the leg back until it 
presses hard against it. In 
doing this, the thigh must be 
doubled up toward the ab- 
domen or the bending of the 
knee will soon become intol- 
erably painful. 

For wounds in the 
thigh, pressure must be 
made in the hollow imme- 
diately below the groin, 
about two-thirds of the way 
from the hip bone to the 
middle line of the body, 
where the artery of the thigh 
(femoral artery) comes out of 
the body, as shown in Fig. 8. Fig. 8. 




76 ACCIDENTS AND EMERGENCIES. 

This can be effected with the thumbs or with 
a rounded stick, or a key handle, or with a 
" Spanish windlass." The artery may also be closed 
by placing in the groin a knotted cloth, or a huge 
round stone, and doubling the leg back on the thigh 
(this is important), and the thigh forward, hard 
against the abdomen. If this latter plan does not 
succeed promptly some other one of those mentioned 
should be tried, and no time be lost in doing it. 

Bleeding from arteries of the scalp can be 
controlled by firm pressure upon and around the 
bleeding point. 

Recapitulation, — To go over this briefly again; 
Remember: first, to keep cool; second, that the 
principal object is to obstruct the artery above the 
cut; and that this can be effected by pressure, in 
the several cases, in front of the bend of the elbow, 
in the armpit, behind the bend of the knee, or just 
below the groin. This can be made with the fingers, 
or with a knot, held hard against the artery by a 
tight bandage or by bending the limb up against it — 
or, in case of the arm, by pressing it hard against 
the chest. Incase of failure, the "Spanish wind- 
lass " is to be applied to the same places. 

In case none of the plans proposed can be carried 
out, a cut that bleeds profusely may be stuffed with 
a rag or dry earth, and this kept in place by pressure, 
with a bandage or handkerchief, or the cut part may 
be forcibly compressed in any way, or a finger thrust 



HEMORRHAGE — BLEEDING. 77 

into the wound and held wherever it seems to do 
most good. 

Finally, let it be remembered that fainting may 
put an end to hemorrhage, yet when consciousness 
is restored this may recur. So this possibility should 
not be overlooked. The treatment of a faint under 
these circumstances is the same as that of any faint, 
in addition to the measures demanded to check the 
bleeding. 



78 ACCIDENTS AND EMERGENCIES. 



Special Hemorrhages. 

Bleeding from the nose is often only Nature's 
way of getting rid of an excess of blood, but it may 
be so profuse as to threaten life. If this be the case, 
of course, medical aid will be summoned ; but until 
it arrives the best thing that can be done is to snuff 
salt and water or vinegar up the nose. A strong 
solution of alum in warm water is also useful ; but 
vinegar is less disagreeable, and will rarely fail to 
check the bleeding, unless the case is beyond any 
except skilled help. 

In hemorrhage from the lungs the blood is 
bright red and generally frothy. It is rarely pro- 
fuse, and yet, as it is usually coughed up and caught 
in a handkerchief, it seems to be so. The amount 
can never be safely estimated in this way. The best 
treatment is rest in bed, with the body raised in the 
sitting posture, and the swallowing of lumps of ice. 
The application of cold to the chest, if the patient 
is not too weak, is of some use, and salt and vinegar 
can be given in teaspoonful doses every fifteen 
minutes. 

In hemorrhage from the stomach the blood 
is usually very dark, looking like coffee grounds. 



SPECIAL HEMORRHAGES. 79 

If it is mixed with any other contents of the stomach, 
its appearance may be masked. In such cases ice 
water or broken ice may be swallowed, and tea- 
spoonful doses of vinegar. Rest in bed must, and 
the application of cold to the stomach may, be em- 
ployed. 

Hemorrhage from the bowels may be treated 
with ice-water injections and the application of ice 
to the abdomen. 

In internal hemorrhage ice-cold cloths may 
be placed upon the abdomen. Rest in bed, with- 
out a pillow, and with the head lower than the body, 
must also be secured. 



80 ACCIDENTS AND EMERGENCIES. 



Transportation of Injured Per- 
sons. 



If injured persons have to be moved from one 
place to another, it is worth while to know how to 
do it with the greatest ease and safety to them. If 
a door, or shutter, or settee is at hand, any of these 
will make a good litter, with a blanket, or shawls, 
or coats for pillows. In lifting a person upon a 
stretcher it should be laid with its foot at his head, 
so that both are in the same straight line. Then 
one or two persons should stand on each side of 
him, and, raising him from the ground, slip him up 
on the stretcher. This can be done smoothly and 
gently, whereas, if a stretcher is laid alongside of 
an injured person, some of those who lift him will 
have to step backwards over it, and in doing so are 
very apt to stumble. If a limb is crushed or broken 
it may be laid upon a pillow, with bandages tied 
round the whole, so as to keep it from slipping about 
(see page 48). Where an injured person can walk, 
he can get much help by putting his arms over the 
shoulders and round the necks of two others. In 
case of an injury where walking is impossible and 



TRANSPORTATION OF INJURED PERSONS. 



81 



lying down is not absolutely necessary, an injured 
person may be seated on a chair and carried, or he 
may sit upon a board or fence rail, the ends of 
which are carried by two men, around whose necks 
he should place his arms, so as to steady himself; or 
two men may carry him seated on their interlocked 
hands, in the way known to children as " Lady to 




FIG. 9. 




London. 7 ' To do this, each of two persons, stand- 
ing face to face, should grasp his right forearm with 
his left hand (its back uppermost), then he should 
grasp his companion's free left forearm with his own 
free right hand (also with its back uppermost), as 
shown in Fig. 9. When no litter can be gotten, the 
body may be supported by a man on each side, with 



82 • ACCIDENTS AND EMERGENCIES. 

their arms placed behind his chest and under his 
hips. In carrying an injured person upon a litter, 




or what serves for one, the bearers ought not to 
keep step ; but when they are not using a litter, they 
should keep step. 



poisons. 83 



Poisons. 



Immediately upon the discovery or suspicion of 
poisoning, some one should be dispatched for a doc- 
tor, if possible, carrying information as to the poison 
taken, so that valuable time may be saved. Mean- 
while the following may be done : — 

i. Unknown Poisons. If the patient should 
vomit, this should be encouraged ; if not, it must 
be provoked. The simplest way to do this is to 
give large draughts of lukewarm water, and thrust 
a finger down the throat. If there be time, and it 
is at hand, a teaspoonful or two of ground mustard 
may be stirred up in the water, or a teaspoonful 
of powdered ipecac, or a tablespoonful of the syrup 
of ipecac. Further, let it be remembered that there 
is no occasion for fastidiousness. Any water will do. 
Water in which hands — or dishes, for that matter — 
have been washed, may, by its very repulsiveness, 
act more quickly than anything else ; and if soap has 
been used, it will be all the better for that, as soap 
is an antidote for acid poisons. The quantity used 
must be large ; the sufferer must be urged to drink 
and drink, a pint at a time, until he can contain no 



84 ACCIDENTS AND EMERGENCIES. 

more, and has been made to vomit over and over 
again. 

After copious vomiting, soothing liquids should 
be given — oil, milk, beaten-up raw eggs — all in 
moderately large quantities. These are especially- 
valuable when the poison has been of an irritating 
character. 

If the sufferer be much depressed in body or mind, 
the hands and feet cold, the lips blue, the face pale, a 
cold perspiration upon the forehead and about the 
mouth, then some stimulant may be administered. 
Strong, hot tea, without milk, is the best, because it 
is a chemical antidote to many poisons. Strong 
coffee is next in value. To either of these can be 
added brandy, whisky, wine, or alcohol, in table- 
spoonful doses for an adult, and half as much for a 
child ; of the spirits may be mixed with a little hot 
water. Warm coverings are not to be forgotten ; 
and if the depression be great, hot water cans or hot 
bricks, wrapped in one or two thicknesses of blanket, 
should be laid by the side of the chest, or a huge 
poultice placed round the body, or a blanket, wrung 
out of hot water and covered with a dry one. 

2. Acid Poisons. Oil of vitriol (sulphuric acid) 
and nitric and muriatic acids are heavy, sometimes 
yellowish-looking, fluids; the first, as its name im- 
plies, not unlike oil in appearance, but very heavy 
in a bottle. The others are lighter, and give off 
extremely pungent, irritating fumes. All discolor 



poisons. 85 

anything on which they fall ; the first blackens pine 
wood, the others turn it yellow. All burn horribly, 
and leave no doubt of their caustic nature. 

For these the proper treatment is to give an alkali. 
A tablespoonful of hartshorn may be mixed with two 
teacupfuls of water, and given; or almost unlimited 
quantities of soda, magnesia, potash, whitewash, 
chalk, tooth powder, whiting, plaster, soap, or even 
wood ashes, stirred up in water. 

After this should come the provoking of vomiting ; 
then the bland fluids mentioned above should be ad- 
ministered, rest secured and stimulation employed, 
if necessary. 

Oxalic acid comes in small, heavy, bright, color- 
less crystals, making a clear rattle in a bottle or jar. 
For this the best antidote is lime in some form. If 
lime water is at hand, it may be given freely, or 
whitewash, tooth powder, chalk, whiting, or plaster 
from a wall. The latter may be crushed and stirred 
up in water, without regard to the grittiness, which 
will not do any harm. 

Carbolic acid is usually in solution, as a thick, 
clear and dusky fluid. When taken by the mouth 
it causes whitening and shriveling of the mucous 
membrane lining it, with intense burning and then 
numbness. There are also nausea, weakness and 
depression, sometimes actual collapse. It is a very 
dangerous poison, because it acts rapidly and be- 
numbs the stomach, so that it is hard to provoke 



Ob ACCIDENTS AND EMERGENCIES. 

vomiting. This must be attempted, however, and 
large draughts of oil or milk given. Rest, warmth 
of the body and stimulation must also be secured. 

3. Alkaline Poisons. The strong alkalies are 
ammonia, or hartshorn — which is a clear fluid with 
an unmistakable odor — -potash and soda, usually dis- 
solved, and sometimes in the form of lye. Liniments 
sometimes contain these substances, and are swal- 
lowed by mistake. 

The alkalies usually burn intensely. They must 
be combated with an acid. Vinegar can always be 
had, and there is nothing better. It should be given 
undiluted, and a pint at a time, if possible. Lemon 
juice may be used, or even orange juice, though the 
latter is too mild an acid to be of much service, 
unless the oranges are very sour. Vomiting should 
then be provoked, and followed by bland acid or 
oily drinks, rest and stimulation, if necessary. 

4. Metallic Poisons. Arsenic, sugar of lead, 
corrosive sublimate and tartar emetic are not infre- 
quently taken by mistake, because they are used for 
various household purposes. 

Arsenic comes as a white, sweetish powder, often 
used to destroy domestic pests, such as rats and 
roaches. It usually excites vomiting and violent 
pain in the stomach. At once large quantities of 
milk, white of egg, or flour and water, or oil and lime 
water must be given. The vomiting must be en- 
couraged or provoked, and dialysed iron given. 



poisons. 87 

This can now be obtained at any drug store, and 
should be given freely, in tablespoonful doses, each 
dose being followed at once by a teaspoonful of 
common salt in a teacupful of water ; or, if this is 
not at hand, equal parts of sulphate of iron (green 
vitriol) and of carbonate of soda may be dissolved 
in separate cups of hot water and then mixed and 
drunk. Afterward vomiting should be again pro- 
voked, followed by a dose of castor oil. 

Paris green is an arsenical preparation. If taken 
as a poison, it must be treated like simple arsenic. 

Sugar of lead comes in white lumps or powder, 
and calls for vomiting, Epsom salts, milk, eggs, and 
castor oil. 

Corrosive sublimate comes in small, colorless 
crystals, or in a clear solution. If taken, vomiting 
must be provoked, and some form of tannic acid 
given. Tea is the handiest thing containing this, 
and its administration should be followed up with 
eggs and milk. 

Tartar emetic, a white powder, is best treated 
in the same way. 

Phosphorus is sometimes chewed off of matches 
by children. It is a poison which acts slowly, and 
affords ample time for securing medical advice. But 
five-grain doses of sulphate of copper, dissolved in 
water, may be given, at intervals of ten minutes, 
until vomiting comes on. Then , a dose of mag- 
nesia should be administered ; but np oil. 



88 ACCIDENTS AND EMERGENCIES. 

Lunar caustic is sometimes swallowed. The 
antidote of this is a very strong brine of salt and 
water, given again and again ; and vomiting should 
be provoked, until the vomited matters cease to have 
a look like thin milk. 

Iodine, in the form of a tincture, is also some- 
times swallowed by mistake. The antidote for this 
is starch and water. 

5. Vegetable Poisons. The vegetable poisons 
are so often taken in consequence of mistakes in the 
use of medicines, that it is a wise precaution that a 
poisonous drug should always be contained in a 
bottle of peculiar shape, or with something peculiar 
attached to its neck, and that there should also be a 
special place in each house where dangerous reme- 
dies, and such as are intended only for external use, 
should be kept. 

Opium preparations are opium, morphine, laud- 
anum, paregoric, black drop and many poisonous 
nostrums sold as soothing-syrups, pain-destroyers, 
and drops for infants. Their symptoms are deep 
sleep, with narrowing of the pupil of the eye to a 
small circle, which does not enlarge in the dark. 
Here emetics must be used promptly and persist- 
ently, and vomiting produced over and over again. 
Strong coffee must be freely given as a stimulant. 
So long as the breathing does not fall below ten 
to the minute, there is no immediate danger of 
death; but opium is a treacherous poison, and 



poisons. 89 

requires all the skill that can be obtained to 
combat it. The important matter is to keep up the 
breathing. The custom of walking a patient up and 
down and slapping him with wet towels is to be de- 
precated, because it adds exhaustion to stupor. If 
an electrical battery can be obtained, and used, it is 
the best thing that can be done. The next is to lay 
the patient upon a lounge and slap his skin with the 
back of a broad brush or with a slipper. This is 
all the rousing that is necessary, so long as the 
breathing keeps above ten to the minute. Should 
it fall below this, or if the breathing should cease, 
artificial respiration should be employed. (See 
pages 12-14.) 

Chloral is a damp, colorless, crystalline substance, 
usually seen in solution. Its symptoms and treat- 
ment are the same as those of opium. 

Strychnine is an intensely bitter, white powder. 
It produces stiffness of the jaws, then of the limbs 
and body. It should be treated by provoking vomit- 
ing, giving a purge, and doses of thirty grains of 
bromide of potash, or twenty grains of chloral, or 
both, to an adult. The greatest quiet must be 
secured. The poisoned person should be put to 
bed in a darkened room, with doors, windows and 
shutters arranged in a way that shall exclude all 
sights, sounds and draughts, though permitting good 
ventilation. 

Aconite is sometimes contained in liniments, and 

G 



90 ACCIDENTS AND EMERGENCIES. 

swallowed by mistake. In such a case vomiting 
must be brought on, and followed by the adminis- 
tration of stimulants. Strong coffee may be used, 
hartshorn (a teaspoonful in a teacupful of water), 
wine, whisky, or brandy. The patient will often 
feel a peculiar numbness or tingling in the arms or 
legs, which is an evidence that the poison has 
entered the blood, and makes the attention of a 
physician imperative. If there is depression, warmth 
should be used, as described when speaking of 
unknown poisons. 

Hemlock, deadly nightshade, the James- 
town (or jimson) weed, monkshood, and toad- 
stools are sometimes eaten, without knowledge of 
their poisonous character. Tobacco, too, some- 
times causes poisonous effects. All produce deep 
depression, and must be treated with vomiting, fol- 
lowed by stimulation and warmth, very much as in 
the case of aconite poisoning. 

Alcoholic liquors are sometimes taken in such 
large quantities as to be poisonous. When this is 
the case there are evidences of deep stupor or 
depression. The course to be pursued is to cause 
vomiting, give hartshorn and water (a teaspoonful in 
a teacupful), and keep the body warm. (See page 
3 2 . Intoxication . ) 

6. Decayed meats or vegetables usually excite 
vomiting, which should be encouraged till the 
stomach is empty, and followed by a dose of castor 
oil and some powdered charcoal; 



POISONS. 91 

Resume. We have now completed the list of 
poisons that are at all common, and have seen what 
should be done in almost any case that is likely to 
occur. In conclusion., let it be remembered that, 
when there is an alarm of poisoning, some one, at 
least, must keep cool ; then that a physician is to be 
summoned (sending him word, if possible, what 
poison has been taken) ; and that, until his arrival, 
the course indicated above should be followed. To 
save time in an emergency, the following table may 
be consulted, which gives the name of each poison 
we have already studied, and the proper treatment 
for it. 

POISON. TREATMENT. 

f Provoke repeated vomiting ; 

Unknown < Give bland liquids; 

(^Stimulate, if necessary. 
Acids — 1 f Give an alkali ; 

Sulphuric, f f Provoke vomiting ; 

Nitric, j- X Give bland fluids ; 

Muriatic, Secure rest ; 

Oxalic, J [Stimulate, if necessary. 

Alkalies — 1 f Give an acid (vinegar) ; 

Hartshorn, Provoke vomiting ; 

Soda, > -I Give bland liquids ; 

Potash, Secure rest ; 

Lye, J [ Stimulate, if necessary. 

f Provoke vomiting ; ") repeat 

Arsenic — "\ I Give dialysed iron and salt ; J several 

Paris green, >-... -j Give dose of castor oil ; times; 

Scheele's green, j Secure rest; 

l_ Stimulate, if necessary. 

f Give Epsom salts, ] repeat several 

Sugar of Lead. \ £° v< ft e vomiting,) times ; 

& J j Give bland liquids ; 

[ Give dose of castor oil. 

(Provoke vomiting, ) repeat 

Give strong tea, without milk, \ several 
Give raw eggs and milk; times; 

Give dose of castor oil ; 
Stimulate, if necessary. 



92 ACCIDENTS AND EMERGENCIES. 

f Provoke vomiting ; 

Phosphorus < Give five-grain doses sulphate of copper; 

(Give dose of magnesia : but no oil. 
Lunar Caustic (nitrate \ f Give strong salt and water, > rep't many 

of silver), j" \ Provoke vomiting, \ times. 

C Provoke vomiting ; 

Iodine < Give starch and water; 

( Give bland fluids. 
Opittm — ") 

Morphine, f Provoke vomiting, repeatedly ; 

Laudanum, > X Give strong coffee, without milk ; 

Paregoric, etc., (Keep up the breathing. 

Chloral, J 

( Provoke vomiting, once or twice ; 

Strychnine ■< Give a purgative ; 

(Secure absolute quiet. 

Aconite \ Provoke vomiting ; 

Acomte \ Stimulate well. 

Jamestown Weedy ~\ 

Hemlock, t -n ^ 

Tobacco, } 

(Give hartshorn and water. 

( Provoke vomiting ; 
Decayed Meat or Vegetables.... < Give a purgative ; 

( Give powdered charcoal. 

To provoke vomiting, warm water may be used 
with or without ground mustard (a tablespoonful to 
a pint of water), or ipecac (a teaspoonful of the 
powder or a tablespoonful or so of the syrup), and 
thrusting a finger down the throat. It is best to give 
large quantities (that is, a pint at a time) of warm 
water whenever vomiting is to be excited. 

Bland liquids are milk, raw eggs, some sort of 
oil, gruel, etc. 

Stimulants are tea, coffee, whisky, wine, etc., or 
hartshorn and water. Of this a teaspoonful in a 
teacupful of water will be enough for a dose. In 
making tea or coffee one must not wait to do it as if 



poisons. 93 

for the table, but mix hot water and the leaves or 
grounds, squeeze them well, stir together, and give 
the whole — leaves, grounds, everything. At the 
same time some may be made regularly, if there are 
conveniences for it. 

Alkaline antidotes are hartshorn and water (a 
tablespoonful in two teacupfuls of water) soap and 
water, lime, whiting, soda, chalk, tooth powder, 
plaster, magnesia, whitewash, and even wood ashes. 

Acid antidotes are vinegar and lemon juice. 

In giving an antidote never wait for it to dissolve. 
Just stir it up in any fluid at hand except oil, and 
have it swallowed immediately. 



94 ACCIDENTS AND EMERGENCIES. 



Domestic Emergencies. 



No less important than the emergencies thus far 
considered, most of which have a sort of public 
significance, are a few more which usually occur 
within the limits of the household and try the know- 
ledge and patience of anxious parents. If these 
emergencies arose only when skilled assistance could 
be had in a moment, they might, perhaps, be omitted 
from a book like this. But they have a way of pre- 
senting themselves at the dead of night, in traveling, 
at the seashore, or in the mountains, where doctors 
are not known or not to be had promptly, and those 
upon whom the burden of meeting them fails may 
not be sorry to have some simple suggestions as to 
what they may do until they can commit their in- 
terests to others better prepared to guard them. 

Cholera morbus produces vomiting and purging 
and violent cramps in the stomach. The pain may 
be so severe as to actually threaten life. There is then 
a pinched expression of the face, and a cool, clammy 
skin. In such cases, something must be done at once 
to relieve the pain. For this, laudanum may be 
given — half a teaspoonful to an adult, or ten drops 
to a child over twelve years old. At the same time 



DOMESTIC EMERGENCIES. 95 

heat must be applied to the stomach. For this pur- 
pose a mustard plaster can be used, or cloths wrung 
out of hot water and sprinkled with turpentine or 
with red pepper. An injection containing a small 
teacupful of warm water or 'milk, to which a table- 
spoonful of tincture of assafoetida has been added, 
often gives great relief. 

Colic causes violent griping pain in the abdomen. 
It is usually due to something indigestible which has 
been eaten. It should be treated by hot applications 
to the abdomen, a purgative by the mouth and an 
injection of water and assafoetida, as already de- 
scribed. 

Vomiting or nausea, due to something objec- 
tionable in the stomach, may be treated by giving ' 
large draughts of pretty hot water. If it be due to 
nervousness or a slight indigestion, it can usually be 
corrected by swallowing small pieces of ice, or table- 
spoonful doses of lime water, or a pinch of soda, or 
thirty drops of aromatic spirits of ammonia in a 
half teacupful of water, together with the applica- 
tion to the pit of the stomach of a mustard plaster, 
or of a flannel cloth wrung out of hot water and 
sprinkled with a tablespoonful of turpentine or some 
red pepper. A lump of ice held against the pit of 
the stomach often does much good. The sufferer 
should always lie down until the nausea passes off. 

Diarrhoea is usually due to a cold or to something 
indigestible which has been eaten. In either case it 



96 ACCIDENTS AND EMERGENCIES. 

is an effort of nature to cure itself of something hurt- 
ful. So, at the start, the best thing to be done is to 
give a mild purge. A small dose of equal parts of 
sweet oil and castor oil, or spiced syrup of rhubarb 
or magnesia is the best. After this, if the move- 
ments of the bowels soon return, half a teaspoonful of 
ginger in a wineglass full of water may be given 
after every passage. If this does not check the diar- 
rhoea, ten drops of laudanum may be given to an 
adult after each passage. For an adult, also, an in- 
jection, made of half a small teacupful of boiled 
starch to which twenty or thirty drops of laudanum 
have been added, often gives immediate relief. For 
a child over two years old one drop of laudanum may 
be given after each passage, until the diarrhoea seems 
checked or there is some evidence of drowsiness. 

Croup. Attacks of spasmodic croup, though very 
alarming, are rarely dangerous. When they occur 
the little sufferer should be given an emetic of a tea- 
spoonful of syrup of ipecac or a heaping teaspoonful 
of powdered alum, followed by a draught of warm 
water. Cloths wrung out of water as hot as can be 
borne should be wrapped round the throat and laid 
upon the chest. They should then be covered with 
something to keep the heat in — like oiled silk or a 
dry cloth. 

This is all that can ordinarily be done with ad- 
vantage till a physician arrives. But it usually gives 
decided relief. In this case, and even if it does not, 



DOMESTIC EMERGENCIES. 97 

natural anxiety should not drive parents to be want- 
ing to do something else all the time. They may 
renew the hot cloths as soon as they begin to grow 
cold, but beside this there is nothing to be done but 
to wait until there has been time for the spasm to 
pass off. This is hard to do, it is true ; but it is the 
best thing to be done, and far better than the fuss 
and worry, to parents and child, of trying a variety 
of methods. 

In Whooping Cough there is a strong nervous 
element, and a spasm of coughing is often brought on 
by the example of another child. So, when a child 
is seized with a fit of coughing it ought, if possible, 
to be at once separated from other children, for its 
own good and for theirs. Then, if the fit does not 
pass away in the usual time, it may sometimes be cut 
short by pressing a lump of ice against the chest, or 
by placing hot cloths there. 

Asthmatic attacks may be treated in several 
ways. One method is founded upon the fact that 
asthma is a nervous manifestation, which grows 
worse, the more the attention is directed to it. If 
the attention can be diverted the attack will often 
pass off. Occurring, as it usually does, at night, 
the darkness, the surprise, the absence of surround- 
ing activities, increase its effects. If the sufferer be 
a man, and will get out of bed, put on his gown and 
slippers, light his gas and take a book or paper and 
begin to read, he will, in many cases, soon find his 



98 ACCIDENTS AND EMERGENCIES. 

trouble diminishing and finally disappearing. If he 
be a smoker, his cigar or pipe will help him in this 
emergency. 

A less agreeable method is to take an emetic. 
Another is to smoke the asthma cigarettes sold in 
every drug store. Another is to get some steaming 
hot water in a basin, pour into it a tablespoonful 
or more of Hoffman's anodyne, and breathe the 
ascending vapors. One of the best remedies is a 
full dose of opium in some form — for an adult, 
thirty drops of laudanum, or two teaspoonfuls of 
paregoric. As soon as this takes effect the spasm 
of asthma will disappear. 

Nervous attacks, which may take the form of 
shivering fits, are to be treated by putting the patient 
to bed, if possible, and giving strong hot coffee, or 
hot sweetened water, and by applying heat to the 
body by a bath or hot cloths or bottles, with a mild 
mustard plaster or turpentine placed on the pit of 
the stomach. A teaspoonful of camphor water, of 
valerian, or of Hoffman's anodyne, will often prove 
of great service. 

Toothache, depending upon a cavity in a de- 
cayed tooth, is usually very easy to stop. To do 
this a fine crochet needle should have a very small 
bit of clean cotton twisted round its point, and 
with this the hole in the tooth should be thoroughly 
swabbed out. Then the point of the crochet needle 
should be cleaned and another little ball of cotton, 



DOMESTIC EMERGENCIES. 99 

like a very small shot, be dipped in oil of cloves 
and caught up with the end of the needle. It 
should then be laid in -the hollow tooth and poked 
in, and rammed and packed down hard with the end 
of the needle. This rarely fails to cure such a tooth- 
ache. 

When toothache is not due to a hollow tooth, a 
somewhat severe but usually efficient plan of treat- 
ment is to lay between the gum and the cheek a 
little wad of cotton, the size of the end of the 
thumb, soaked in spirits of camphor. This makes a 
sort of blister, but generally cures the toothache, 
which is much harder to bear. 

Earache should always suggest an examination 
of the teeth, and if one be found decayed, it must 
be extracted or at least cleaned out and packed with 
cotton and oil of cloves, as described in speaking of 
toothache. For, many earaches depend upon diseased 
teeth. 

In case this is not called for, or does no good, a 
folded cloth, wrung out of hot water, with a tea- 
spoonful of laudanum poured over it, or a big, hot 
poultice — for which hops is the best material — should 
be applied to the side of the head and kept as hot as 
possible. Hot drinks should be given also, and 
enough laudanum to cause relief from pain. 

The occurrence of an earache should always lead 
to consulting a doctor, for it is often of importance 
as a sign of disease which may seriously affect the 
hearing. 



100 ACCIDENTS AND EMERGENCIES. 

Poisoning by the common poison vine 

causes red blotches, and wheals, and blisters on the 
skin, with great burning and itching. It is best 
treated by applying cloths soaked in a solution of 
soda, a tablespoonful to a teacupful of hot water. 
Dusting with magnesia or ordinary toilet powder is 
also grateful. 



SIGNS OF DEATH. 101 



Signs of Death. 



In the absence of a physician it sometimes becomes 
important that others shall be able to determine 
whether death has taken place or not. The occur- 
rence of death can be recognized by the following 
signs : The breathing and pulse cease, the surface 
becomes pale, the muscles relax, the lower jaw falls 
a little, the " sight 7 ' of the eye becomes dull and 
glazed, the upper lid falls so as to partly cover the 
eyeball, then the whole body gradually cools to the 
temperature of the surrounding air and becomes 
rigid, while later decomposition sets in, and usually 
shows itself first by a greenish discoloration of the 
surface of the abdomen. 

But it does not require the detection of all these 
signs to determine that death has taken place. The 
cessation of breathing and of the heartbeat is a safe 
basis to an opinion. It requires some care, how- 
ever, to decide that there is no breathing or circula- 
tion. To test the former, a cold piece of polished 
steel — like a razor blade or table-knife — can be held 
under the nose and before the mouth. If no moisture 
condenses upon it, it is safe to say there is no breath- 
ing. To test the cessation of the heartbeat, it is not 



102 ACCIDENTS AND EMERGENCIES. 

enough to feel for the pulse at the wrist. The 
largest blood vessel in the body (see Frontispiece) 
runs directly down from the heart, along the left side 
of the spinal column, and its strong beating can be 
plainly felt in most people by pressing the finger tips 
firmly down toward the backbone, at the point below 
the breast bone called the "pit of the stomach." 
In this place the slightest pulsation of the heart 
can be felt if the walls of the abdomen permit 
the finger to get near the backbone, and here exami- 
nation should be made before deciding that the heart 
has ceased to beat. Another test is listening over 
the region of the heart, in front of the left side 
of the chest. An acute ear can always detect 
the movement of the heart by sounds made by its 
valves, which, when perfect, sound like the syllables 
"ub-dup," " ub-dup," and soon. If careful listen- 
ing fails to detect the heart sounds, and the cold 
metal fails to show any evidence of breathing, the 
individual may certainly be said to be dead. 

When, in addition to these signs, paleness, mus- 
cular relaxation, a glazing eye, increasing coldness 
and rigidity come on, it hardly requires the onset of 
decomposition — the infallible sign — to prove, beyond 
any possibility of doubt, that death has occurred. 

The electrical battery may be used in doubtful 
cases. Electricity distinguishes with absolute certainty 
between life and death. For two or three hours 
after the stoppage of the heart the whole of the 



SIGNS OF DEATH. 103 

muscles of the body have completely lost their elec- 
tric excitability. When stimulated by electricity 
they no longer contract. If, then, when electricity 
is applied to the muscles of the face, limbs, or trunk, 
after supposed death, there be no contraction, death 
has occurred. No faint, no trance, no coma, how- 
ever deep, can prevent the manifestation of electric 
muscular contractility. 

But ordinarily it is very easy to decide between 
death and life ; and the fear of being buried alive, 
which torments many people, is altogether without 
good foundation. The stories upon which it rests 
are such as an excited imagination might easily in- 
vent, and natural fear propagate, but they do not 
bear critical investigation. In certain European cities, 
for many years, the bodies of hundreds of thousands 
of those supposed to be dead have been placed in 
rooms where ingenious appliances and careful watch- 
ing have been used to detect the slightest evidence of 
life, and in not a single case has a mistake been found 
to have been made. 



104 ACCIDENTS AND EMERGENCIES. 



Supplies for Emergencies. 



The suggestions in the preceding pages have been, 
as far as practicable, such as could be carried out 
without having made any special provision for them. 
Nevertheless, occasionally appliances and remedies 
have been suggested, which would very much facili- 
tate the treatment, if they were accessible. These 
may be divided into medical and surgical. They 
may be arranged separately or together, but the 
former arrangement would probably best suit indi- 
vidual necessities. 

SURGICAL CASE. 

A surgical case suitable for almost any emergency 
should not contain so many things as to confuse one 
who has not a medical education. Its supplies 
should be few and simple, such as — 

i. Some absorbent cotton. 

2. A roll of old muslin or linen. 

3. Bandages, 2^ inches wide and 6 yards long, 
rolled up. 

4. Rubber adhesive plaster, in strips 3 inches wide, 
and not less than a yard long. 

5. Scissors. 



SUPPLIES FOR EMERGENCIES. 105 

6. Pins. 

7. Needles, threaded with stout thread. 

8. A bottle of hartshorn, with a glass or rubber 
stopper. 

9. A bottle of laudanum, with dose marked on it. 
10. A bottle of good whisky or brandy. 

USE OF THE CONTENTS OF THE SUR- 
GICAL CASE. 

1. Absorbent cotton can be obtained at any 
drug store. It is perfectly clean and soft, and is 
prepared in such a way that it — instead of resisting 
moisture, as ordinary cotton does — will absorb it 
with great rapidity. Thus it will take up discharges 
from wounds ; and when a cool or hot application is 
desired, it can be soaked with cool or hot water. 
Sometimes it is very convenient to put it on dry 
and then squeeze the water upon some part of it 
from a sponge, when every part will rapidly become 
saturated. 

For padding splints, or making cushions to prevent 
pressure of any kind, there is nothing so good as 
absorbent cotton. 

2. Old muslin or linen can be torn into any 
shape or size that may be required, and can be used 
to spread poultices upon. It is also useful to make 
broad slings of. 

3. Bandages of the kind described are used to 
keep applications in place, to secure parts to splints, 

H 



106 



ACCIDENTS AND EMERGENCIES. 



and to prevent injurious motion. The simplest way 
to apply them is to make circular turns around any 
part. When the latter is of even size this is a very 
easy matter. Where the part is larger at one end 
than the other, the ordinary circular turns would not 
fit smoothly. To accomplish this the rule is to begin 
at the small end and make a few turns, round and 
round, one immediately over the other, and then to 
begin to move up the limb spirally. So long as a 
turn can be made to smoothly, overlap the one before 
it about one-third, this spiral is all that is required. 
But as soon as it puckers the bandage is not carried 
on as before, but is turned down, so that the inner 
face now looks out, and the bandage, instead of 




Fig. 12. 



passing up, passes downward, so as to make a sort 
of inverted V — so, A- On now carrying the ban- 
dage on round the part, it will be found that it comes 



SUPPLIES FOR EMERGENCIES. 107 

to the front, just overlapping the preceding turn, 
and the same process can be repeated, until the 
whole bandage is neatly applied. (See Fig. 12.) 

At joints, like the ankle, knee, and elbow, the 
bandage may make a sort of figure of 8, the middle 
or crossing part being in the bend of the joint, and 
the two loops, one above and one below it. 

Bandages should never be put on so tight as to 
cause pain, and never drawn tighter above than below. 

Bandages may be fastened by pins, by stitching, by 
strips of adhesive plaster, or by splitting the end and 
carrying one tail on as before and turning the other 
back to meet it and then tying the two together. 
For narrow bandages, the latter is the simplest plan ; 
for wide ones some one of the others is better. 

The width of 2^ inches is that which is oftenest 
convenient. When a narrower bandage. is called for 
— as for a finger — one of the former may be torn 
down the middle ; or, if rolled up, it can be laid on 
a firm surface and Jhe whole roller cut in half with a 
sharp knife, just as one would cut a sausage. This 
quickly and easily makes two good finger bandages. 

4. Rubber adhesive plaster is better than any 
other kind, because it can be applied without heat or 
moisture. It sticks of itself. When applied to a 
hairy part, the hair should be shaved off, if possible. 
If not, when the plaster comes to be removed, it 
must be soaked off, or it will pull the hair out and 
cause great pain. 



108 ACCIDENTS AND EMERGENCIES. 

Another point to be remembered is that, in chang- 
ing adhesive plaster dressings only so much should be 
removed as is necessary or as cleanliness demands. 
The rest may be left on and the new dressing applied 
up to it or over it. In the end all can be soaked off 
together. 

The plaster is most convenient to use when in 
strips, which can be cut easily and without waste if 
needed smaller, and additional strips applied side by 
side, if a greater width is wanted. 

5, 6, 7. The use of scissors, pins and needles 
need not be explained. 

The points of pins should never be left sticking 
out, and care should be used to avoid sticking either 
pins or needles through a patient's skin. 

8. Hartshorn is to be used as a stimulant to the 
heart and to the nervous system. A teaspoonful 
may be put into a tumblerful of water and a teaspoon- 
ful of the mixture given every few minutes. Its use 
by the nose everybody is familiar with. Yet it may 
be worth while to say that a full bottle of hartshorn 
should never be brought near to a patient's face. The 
stopper may be wetted and held under the nose, or a 
few drops put on a handkerchief, or the hand, and 
used in the same way. 

9. The laudanum bottle should be marked 
"-Poison !" and have the dose marked on the label. 
In surgical cases, where there is much pain, a full 
dose is called for, and to give less is to trifle with 
the sufferer. 



SUPPLIES FOR EMERGENCIES. 109 

As already remarked, laudanum is one of the very- 
best local applications to wounds and bruises. It 
can be used by soaking a proper quantity of absorbent 
cotton, or a piece of old muslin, and laying it 
upon the injured part. 

10. About the whisky, it may be remarked, 
that a large dose is almost invariably useless or in- 
jurious. Even for an adult — unless a confirmed 
drinker — the proper dose is a teaspoonful in a small 
quantity of hot water — or cold water, if hot cannot 
be had — repeated every few minutes until some 
effect is produced, or a couple of ounces — about 
half a small teacup ful — have been given. 

HOW TO MAKE POULTICES. 

Poultices. The commonest materials for poul- 
tices are bread, flaxseed, hops and mush. A hop 
poultice is made by pouring hot water upon hops till 
they are well moistened. A bread poultice is made 
by soaking the inside of bread in hot water or milk, 
and mashing it quite soft and even. With flaxseed 
or corn-meal the way is to put the poultice material 
on a plate, and add just enough hot water to moisten 
it. This is worked in with a large spoon or table- 
knife, just as a salad dressing is made. Then to 
this thick but damp mass, enough hot water is grad- 
ually added and worked in until the whole is almost 
soft enough to run, but not quite. Poultices should 
be spread thick. To spread a poultice, a piece of 



110 ACCIDENTS AND EMERGENCIES. 

fine old muslin (or a piece of open-meshed stuff, 
such as cheese cloth is made of, can be used), twice as 
long as the poultice is to be, is laid on a flat surface, 
and one-half of it spread smooth with the poultice 
material. The other half is to be brought over and 
pressed down on top of the poultice material, or 
another piece of muslin, or a piece of tarletan can 
be used for this purpose, so that the poultice material 
shall not come into immediate contact with the 
skin i then, when it comes to be removed, it will come 
off easily, all at one time, and not leave any behind 
to stick to the skin. 

A poultice must be put on hot. To secure this, 
it may be spread over a hot plate. A simpler plan, 
however, is to take the finished poultice up by its 
edges and lay it for a moment or two on something 
hot, or dip it into a vessel containing boiling water. 
Care must, however, be taken not to put on a 
poultice so hot as to burn. 

To keep a poultice warm when applied, it should 
be covered with oiled silk or several folds of 
bandage. 

It may be remarked that nothing has been said 
here about the use of " lead water and laudanum " 
or arnica, so often recommended for bruises and 
cuts. The reason for this omission lies in the fact 
that neither has any merit superior to that of cold 
water or laudanum. When a part is hot and angry, 
there is nothing better for it than the use of cold 



SUPPLIES FOR EMERGENCIES. Ill 

water, constantly renewed until the heat and irritation 
have subsided. When pain is to be combated, 
laudanum alone is the best thing to use locally. 

MEDICINE CHEST. 

A small box can be bought, or made, to hold a 
few things likely to be useful in accidents or sudden 
sickness. It ought to contain — 

Absorbent cotton. 

Sticking plaster — Rubber plaster is best, because 
it requires neither heat nor moisture for its ap- 
plication. 

Bandages of muslin or flannel. 

Thread and needles. 

Pins. 

Vaseline. 

i. Aromatic spirits of Ammonia. 

2. Tincture of Assafoetida. 

3. Oil of Cloves. 

4. Hoffman's Anodyne. 

5. Syrup of Ipecac. 

6. Laudanum. 

7. Magnesia. 

8. Mustard. 

9. Paregoric. 

10. Spiced Syrup of Rhubarb. 

11. Turpentine. 

To these may be added, if quite convenient, 
camphor water, essence of ginger, lime water, and 
sweet spirits of nitre. 



112 ACCIDENTS A^D EMERGENCIES. 

Of the eleven first named, a convenient quantity 
to have would be two fluid ounces ; except of No. 3, 
oil of cloves, of which a fluid drachm would be 
plenty, and No. 7, the magnesia, and No. 8, the 
mustard, of both of which an ounce would suffice. 

The laudanum and paregoric ought to be in bottles 
of an altogether different shape from that of those 
containing the other remedies ; and they, and that 
of the oil of cloves, should be marked Poison ! and 
have a tape tied to their necks, so that it could 
be felt in the dark. Each bottle should have its 
proper dose on the label. 

DOSES AND USES OF THE MEDI- 
CINES. 

1. Ammonia. The aromatic spirits of ammonia 
— not hartshorn — is a valuable remedy in cases of 
sick stomach, and even vomiting. It is also useful in 
cases of nervous or sick headache, as well as in 
simple nervousness. The dose is, for an adult, twenty- 
five drops ; for a child, ten drops, in about a wine- 
glassful of water. This may be given every ten 
minutes, almost indefinitely. 

2. Assafcetida. The tincture of assafoetida is a 
nerve tonic, and also very soothing to the bowels. 
There is nothing better for causing the expulsion of 
wind. The dose is, for an adult, a teaspbonful ; for 
a child, twenty drops, in a tablespoonful of water. 
It can often be used as an injection when it could 



SUPPLIES FOR EMERGENCIES. 113 

not be given by the mouth. In this case, the quan- 
tity to be given is a tablespoonful for an adult and a 
teaspoonful for a child, in a small teacupful of warm 
water. 

3. Cloves. The oil of cloves is useful as a local 
application in toothache. It is also helpful in indi- 
gestion, in doses of three drops for an adult, and one 
drop for a child. It can be given rubbed up with a 
little sugar, or in a teaspoonful of sweet oil. 

4. Hoffman's Anodyne is useful in cases of 
hysterics and nervous fright or chills. The dose is, 
for an adult, a teaspoonful in a wineglassful of water. 
Children rarely require medicines of this sort. But 
when they do, as is the case with certain high-strung 
children, half the dose for an adult may be given. 

5. Ipecac. The syrup of ipecac is a fairly good 
emetic. But it must be used freely. An adult should 
be given a good tablespoonful, and an infant as near 
a teaspoonful as possible. It will do no harm, and 
when an emetic is called for, it is no time to run any 
risk that the dose given may not be large enough. 
It is often usefully employed in cases of poisoning, 
convulsions, croup, whooping cough or asthma. 

6. Laudanum. Laudanum is the tincture of 
opium, and has all its properties. It is one of the 
most useful drugs in the world, and yet it is a danger- 
ous one. There need, however, be no fear of poi- 
soning with any preparation of opium if ordinary 
doses are given, and if these doses are not given closer 



114 ACCIDENTS AND EMERGENCIES. 

together than half an hour, and if they are stopped as 
soon as pain is decidedly lessened or drowsiness 
comes on. Occasionally, small doses of opium cause 
great alarm, but there is much less fear about opium 
poisoning among doctors now than there used to be. 
It may be considered safe to give twenty-five drops of 
laudanum to any adult, when there is severe pain, 
and to repeat this dose every half hour till the pain 
is lessened or drowsiness begins to appear. One of 
the signs of the effect of opium on the system is a 
contraction of the pupil of the eye, which does not 
expand in the dark. This ought always to lead to a 
discontinuance of any preparation of opium which 
has been used. 

To check diarrhoea, sometimes, a drop of laudanum 
every hour will prove successful very soon. Yet, 
ten or fifteen drops may be given to an adult after 
each movement, if the smaller quantity does not 
suffice. 

For cuts and bruises there is no better application 
than pure laudanum. A soft cloth soaked in lauda- 
num can be bound on, and occasionally wetted with 
it, without removal. It quiets pain and promotes 
healing. The same application is often very sooth- 
ing in face ache, toothache and earache, as well as 
in the pains of rheumatism and neuralgia. (See 
"Paregoric") 

7. Magnesia. Magnesia is a mild remedy to 
open the bowels, usually employed for children. 



SUPPLIES FOR EMERGENCIES. 115 

The dose being a teaspoonful, given in water or 
milk. It may also be used for sour stomach, when a 
pinch will generally be enough. 

8. Mustard. In the use of ground mustard for 
plasters it should always be mixed with an equal 
part of flour. Even then it acts quickly and must 
be removed in a few minutes, as soon as the skin is 
well reddened. Where it is desired to leave a mus- 
tard plaster on for more than a few minutes, it 
should be made of one part mustard to three or more 
of flour. Every mustard plaster should be removed 
as soon the skin becomes red, and not allowed to 
make a blister, because such blisters are excessively 
painful and very hard to heal. 

As an emetic, mustard is used by stirring a tea- 
spoonful of the ground seeds in a teacupful of luke- 
warm water. 

9. Paregoric. Paregoric is an opium preparation 
which contains, besides opium and other things, some 
camphor. It is the best preparation for children, 
because the dose is easier to measure than that of 
laudanum. An infant a few hours old will stand 
three drops, and in a few days, five. In a month, ten 
are not too many, and twenty may be given any time 
after six months. An adult can take a tablespoonful. 
It may be used internally in all the cases where lauda- 
num has been recommended. (See " Laudanum.") 

10. Rhubarb. The spiced syrup of rhubarb is an 
excellent mild laxative for the bowels. A teaspoon- 



116 ACCIDENTS AND EMERGENCIES. 

ful is the dose for an infant or small child. It is 
useful at the beginning of a diarrhoea in children, 
as it empties the bowels of what irritates them, 
and also has a soothing and healing influence. 

ii. Turpentine. Spirits, or oil, of turpentine can 
be used wherever mustard has been recommended as 
an external application. For this purpose a soft 
flannel or muslin cloth should be dipped in turpen- 
tine, wrung out nearly dry, laid on the surface and 
covered with oiled silk or a few thicknesses of dry 
cloth, to prevent evaporation. 

Red pepper may sometimes be used instead of 
mustard, though it is more energetic in its action. 
When moistened and applied to the skin red pepper 
first causes a feeling of warmth, and later of intense, 
fiery burning. If left on long enough it will cause a 
blister. But this ought never to be done. Red pep- 
per may be used in cases of colic or cholera morbus, 
where it quiets pain by its counter-irritant effect, and 
stimulates the nervous and circulatory systems. In 
nausea it sometimes does good by the latter process. 



INDEX 



PAGE 

Abdomen, wounds of 53 

Accidents, railroad and machinery 61 

Acids, as antidotes 93 

burns with 37 

poisoning by 84 

Aconite, poisoning by 89 

Alcohol, poisoning by 90 

as a stimulant 65 

Alkalies, as antidotes 93 

as poisons 86 

burns with 37 

Ammonia, as an antidote 93 

as a medicine 112 

as a poison 86 

as a stimulant 108 

Antidotes, to prepare 92 

(See various poisons). 

Apoplexy. • • • • • • 3 2 

Arsenic, poisoning by 86 

Arteries, wounds of 71 

in arm 72, 74 

in foot 75 

in forearm 73 

in hand 73 

in leg 75 

in scalp 76 

in thigh 75 

Asthmatic attacks 97 

Back, broken 50 

Bandaging 106 

Bites , of cats 58 

of dogs 58 

of rats 58 

of serpents 57 

Black-drop, poisoning by 88 

Bland fluids 92 

Bleeding. (See Hemorrhage.) 

Bloodvessels, location of 67 

Bones, broken. (See Fracture.) 

Brain, disorder of 25 

injuries of 34 

Bruises 52 

Bugs, in ear 23 

Burns 35 



11 



PAGE 

Capillaries 69 

Carbolic acid, poisoning by 85 

Carron oil 36 

Catalepsy 33 

Cat bite 58 

Caustic, burns with 37 

poisoning by 87 

Chloral 89 

Choking 16 

Cholera morbus 94 

Circulation, description of 67 

disturbance of. 25 

Cleansing wounds 54 

Cold and heat, effects of. 40 

Colic 95 

Collapse. (See Shock.) 

Collar bone, fracture of. 49 

Contusions 52 

Convulsions 31 

Corrosive sublimate, poisoning by. 87 

Cramps 94, 95 

Croup , 96 

Crush 63 

Cuts. (See Wounds, incised.) 

Cut throat 54 

Death, signs of 101 

Decayed meats or vegetables 90 

Depression. (See Shock.) 

Diarrhoea 95 

Dislocations 43 

Dog bites 58 

Drowning 12 

Drunkenness. (See Intoxication.) 

Ear, foreign bodies in 22 

Earache 99 

Emergencies, domestic 94 

Emetics 92 

Epilepsy 30 

Eye, black 52 

lime in 22 

splinters in 56 

Fainting 28 

7 



118 



INDEX. 



PAGE 

Fishhooks 55 

Fits 24, 30, 31 

Fluids, bland. 92 

Foreign bodies, in ear 22 

in eye 20 

in mouth 18 

in nose 22 

in throat 17 

in windpipe 17 

Fractures 46 

compound 51 

Freezing 40 

Gases, noxious 16 

Glass, splinters of. 56 

Gunshot wounds 59 

Hanging 16 

Hartshorn. (See Ammonia.) 

Heat, effects of 35 

exhaustion 38 

stroke 37 

Hemlock, poisoning by 90 

Hemorrhage 67 

capillary 70 

from arteries 71 

from veins 71 

from bowels 79 

from lungs 78 

from nose 78 

from stomach 78 

internal 79 

Hooks, fish 55 

Hydrophobia 58 

Hysterics 29 

Insects, in ear 23 

stings of 57 

Insensibility 24 

Intoxication 32, 26 

Iodine, poisoning by 88 

Jamestown weed, poisoning by — 90 

Jaw, dislocation of 43 

fracture of. 49 

Joints, injuries of. 43 

Laudanum • 113 

poisoning by 88 

Lead, sugar of, poisoning by 87 

Lightning stroke 39 

Lime, in eye 22 

Liniments containing poison 86 

Liquids, bland 92 

Litters for injured persons. . ... . bo 



PAGE 

Lungs, hemorrhage from 78 

Lye, burns with 37 

poisoning by 86 

Machinery accidents 61 

Meats, decayed, poisoning by 90 

Medicine chest m 

use of 112 

Monkshood, poisoning by 90 

Morphine, poisoning by 88 

Muriatic acid 84 

Mustard, 115 

Nausea 95 

Needles, wounds with 55 

Nervous attacks 98 

Nightshade, poisoning by 90 

Nitric acid 90 

poisoning by 84 

Nose, bleeding from 78 

foreign bodies in 22 

Oil of vitriol. (See Sulphuric Acid.) 

Opium, poisoning by 88 

Oxalic acid, poisoning by 85 

Paregoric, as a medicine 115 

poisoning by 88 

Paris green 87 

Phosphorus 87 

Pin wounds 55 

Poisons 83 

table for treatment 91 

Poison vine 102 

Potash, poisoning by 86 

Poultices 109 

Railroad accident injuries 61 

Rat bites 58 

Respiration, artificial 12 

obstructions to 12 

Resuscitation, from drowning 12 

from opium stupor. 88 

Scalds 35 

Shock 64 

Silver, nitrate of. (^See Caustic, lunar.) 

Skull, fracture of 50 

Snake bites 57 

Soda, poisoning by 86 

Spanish-windlass 74 

Spinal column, fracture of 50 

Spitting blood. (See Hemorrhage 

from Lungs.) 
Splinters 56 



INDEX. 



119 



PAGE 

Splints 50 

Sprains 42 

Stimulants 15, 92, 84, 108, 109 

Stimulation 15, 65 

Stings of centipedes 57 

scorpions 57 

serpents 57 

tarantulas 57 

insects 57 

Stomach, hemorrhage from 78 

Strangling (Strangulation) 16 

Stunning 34 

Strychnine, poisoning by 89 

Sublimate, corrosive, poisoning by. 87 

Suffocation 16 

Sugar of lead, poisoning by 87 

Sulphuric acid, poisoning by 84 

Sunburn 37 

Sunstroke. 37 

Supplies for emergencies 104 

Surgical case 104 

use of 105 

Tartar emetic, poisoning by 87 

Thorns 56 

Toadstools, poisoning by 90 



PAGE 

Tobacco, poisoning by 90 

Toothache •. 98 

Transportation of the injured 80 

Unconsciousness 25 

doubtful cases... 26 
treatment of 28 

Vegetables, decayed, poisoning by 90 

Veins, wounds of. 71 

Vitriol, oil of 84 

Vomiting, to allay 95, 84 

to produce 92 

Washing wounds 54 

Whooping cough 97 

Windlass, Spanish 74 

Wounds 52 

cleansing of 54 

contused 53 

gunshot 59 

incised 53 

lacerated 54 

poisoned 57 

punctured 55 



THE AMERICAN HEALTH PRIMERS. 

EDITED BY W. W. KEEN, M. D., 

Fellcrw of the College of Physicians of Philadelphia. 

12 Volumes. 32mo. Cloth Binding, 50c. Paper Covers, 30c. 

This Series of Health Primers is prepared to diffuse as wide- 
ly and cheaply as possible, among all classes, a knowledge of 
the elementary facts of Preventive Medicine. They are in- 
tended incidentally to assist in curing disease, and to teach 
people how to form correct habits of living and take care of 
themselves, their children, employees, etc. 

They are written in a plain, untechnical style, by well-known 
professional gentlemen, with especial reference to our Climate, 
Sanitary Legislation and Modes of Life. 

I. HEARING AND HOW TO KEEP IT. With Illus- 
trations. By Chas. H. Burnett, m.d., of Philadelphia, 
Aurist to the Presbyterian Hospital. With Illustrations. 

Contents. — The Structure of the Ear; The Physics and 
Physiology of Sound and Hearing; Diseases and Injuries of the 
Ear, including Deaf-Dumbness and the avoidance of improper 
treatment; The Care of the Ear in Health and Disease; The 
Relief of Deafness, and the Education of Deaf Children. 

II. LONG LIFE AND HOW TO REACH IT. By J. 
G. Richardson, m. d., of Philadelphia, Professor of 
Hygiene in the University of Pennsylvania. 

Contents. — Introductory Considerations, Causes of Disease 
and How to Avoid Them ; Heat and Cold as Causes of Disease ; 
Contagious Diseases and How to Escape Them; Rules regard- 
ing Proper Clothing; Pure Air; Ventilation; etc., and the Fatal 
Effects of Impure Air ; Pure Water and the means of obtaining it ; 
and where not to get it; Baths, their Value and Evils; Houses, 
Drains, etc. ; Food and Digestion; Modes of Cooking, etc.; Im- 
pure and Adulterated Food and Drink, and the means to Detect 
Them ; Exercise, and How and When to take it; Sleep, Defi- 
ciency of,Means of Promoting, etc.; The Mind; Brain Diseases; 
Intellectual Labor, etc.; The Trichinae or Pork Worm ; Insects, 
Ringworm, etc.; Old Age, and the best way to meet it. 

III. THE SUMMER AND ITS DISEASES. By 
James C. Wilson, m.d., of Philadelphia, Lecturer on 
Physical Diagnosis in Jefferson Medical College. 

Contents. — The Summer: Sunstroke and Heat Fever; Sum- 
mer Diarrhoea and Dysentery ; Cholera-Infantum and Chil- 
dren's Diseases; Summer and Autumnal Fevers; Summer Colds 
and Hay Asthma; The Skin in Summer and Its Diseases, etc. 

IV. EYESIGHT AND HOW TO CARE FOR IT. With 
Illustrations. By George C. Harlan, m.d., of Philadel- 
phia, Surgeon to the Wills (Eye) Hospital. 

Contents. — Introduction ; The Anatomy and Physiology of 
the Eye ; The Ophthalmoscope ; Injuries and Diseases of the 
Eye ; Optical Defects ; Spectacles ; Practical Hints for the 
Care of the Eyes ; Effects of School Life upon the Eyesight, etc. 

5 



The American Health Primers. 



THE AMERICAN HEALTH PRIMERS— (Continued). 

V. THE THROAT AND THE VOICE. With Illustra- 
tions. By J. Solts Cohen, m.d., of Philadelphia, Lec- 
turer on Diseases of the Throat in Jefferson Medical Col- 
lege, and on the Voice in the National School of Oratory. 

Contents. — Part I. — Construction of the Throat; Sore 
Throats ; Diphtheria ; Croup ; Enlarged Tonsils ; Laryngitis ; 
Foreign Bodies and Morbid Growths; Paralysis; Spasm; 
Neuralgia of the Throat ; Catarrhs, etc. Part II. — The Voice ; 
Acoustics ; The Vocal Organ ; Vocal Culture ; Improper Use 
of the Voice ; Vocal Gymnastics ; Defects of and Care of the 
Voice. 

VI. THE WINTER AND ITS DANGERS. By Ham- 
ilton Osgood, m. d., of Boston, Editorial Staff, Boston 
Medical and Stirgical Journal. 

Contents. — General Considerations ; Dangers from Errors 
in Dress ; Carelessness and Ignorance in Bathing ; Inattention 
to Pulmonary Food ; Danger from Overheated Air and Poor 
Ventilation ; Indifference to Sunshine ; Sedentary Life and 
Neglect of Exercise ; Dangers of School Life ; Winter Amuse- 
ments ; Closing Suggestions, etc. 

VII. THE MOUTH AND THE TEETH. With Illus- 
trations. ByJ.W White, m.d., d.d.s., of Philadelphia, 
Editor of the Dental Cosmos. 

Contents. — The Mouth ; Anatomy and Development of the 
Teeth ; Temporary Teeth ; Difficult Dentition ; Permanent 
Teeth ; Nutrition of the Teeth ; Food in its Relations to the 
Teeth; Nervous Relations; Constitutional Peculiarities; 
Varieties, Defects and Irregularities of the Teeth; Tartar; Sali- 
vary Calculus ; Decay ; Caries ; Toothache ; Extraction ; 
Hemorrhage ; Hygiene of the Mouth ; Reparative Treatment; 
Substitution ; Artificial Teeth, etc. 

VIII. BRAINWORK AND OVERWORK. By H. C. 
Wood, Jr., m.d., of Philadelphia, Clinical Professor of 
Nervous Diseases in the University of Pennsylvania. 
Member of the National Academy of Science. 

Contents. — Nervous Diseases Increasing; General Causes 
of Nervous Trouble; Excesses; Exposure, etc.; Effects of 
Emotional and Intellectual Work ; Unnecessary Work; Women's 
Work, etc.; Rest and Recreation; Exercise; Vacations; 
Camping Out; Sleep; Stimulants During Labor; Signs of 
Nervous Breakdown. 

IX. OUR HOMES. With Illustrations. By Henry Harts- 
horne, M. d., of Philadelphia, formerly Professor of 
Hygiene in the University of Pennsylvania. , 

Contents. — Introduction ; Situation ; Construction ; Light ; 
Warmth; Ventilation; Water Supply; Drainage; Disinfection; 
Population; Workingmen's Homes. 



The American Health, Primers. 



THE AMERICAN HEALTH PRIMERS— (Continued). 

X. THE SKIN IN HEALTH AND DISEASE. With 
Illustrations. By L. D. Bulkley, m.d., of New York, 
Physician to the Skin Department of the Demilt Dispensary 
and of the New York Hospital. 

Contents. — Anatomy and Physiology of the Skin ; The 
Care of the Skin in Health ; Diseases of the Skin ; Parasites, 
etc.; Diet and Hygiene in Diseases of the Skin. 

XI. SEA AIR AND SEABATHING. With Illustrations. 
By John H. Packard, m.d., of Philadelphia, Surgeon to 
the Episcopal Hospital. 

Contents. — Introduction ; Different Seaside Resorts ; Mud, 
Sand,Turkish and other Baths ; Sea Bathing ; How to Float and 
Swim; Accidents; How to Treat the Apparently Drowned; 
Effects of Sea Bathing for Invalids; Cottage Life and Amuse- 
ments at the Seashore ; Sanitary Matters ; The Seashore as a 
Winter Resort ; Excursions to the Seashore. 

XII. SCHOOL AND INDUSTRIAL HYGIENE. By 

D. F. Lincoln, m.d., of Boston, Mass., Chairman Depart- 
ment of Health, American Social Science Association. 
Contents. — Part I. — School Hygiene ; General Remarks ; 
Mental and Emotional Strain of Scholars ; Amount of Study ; 
Growth and Exercise; Care of the Eyes; School Desks and 
Seats; A Model School Room; Ventilation and Heating; Situ- 
ation; Drainage, etc.; Private Schools ; Colleges; Contagious 
Diseases. Part II. — Industrial Hygiene ; Injurious Effects of 
Inhaling Dust and Poisonous Substances ; Injuries from 
Atmospheric Changes ; Over-use of Certain Organs ; Regula- 
tion of Hours of Labor; Duration of Life in Various Occupa- 
tions, etc. 

The sales of these handy volumes have already reached many 
thousands, attesting their popularity and value, and proving 
that they need only to be brought to the attention of thinking 
people to be appreciated. 

RECOMMENDATIONS. 

" Each volume of the 'American Health Primers ' the Inter- 
Ocean has had the pleasure to commend. In their practical 
teachings, learning and sound sense, these volumes are worthy 
of all the compliments they have received. They teach what 
every man and woman should know, and yet what nine-tenths 
of the intelligent class are ignorant of, or at best have but a 
smattering knowledge of." — Chicago Inter- Ocean. 

" The series of 'American Health Primers " deserves hearty 
commendation. These handbooks of practical suggestions are 
prepared by men whose professional competence is beyond 
question, and, for the most part, by those who have made the 
subject treated the specific study of their lives." — N. Y. Sun. 

*#* Single Volumes, 50 cents, in Cloth Binding; 30 cents in 
Paper Binding. 



8 Popular Science, etc. 

ALCOHOLIC INEBRIETY, From a Medical Standpoint. 
With Illustrative Cases from the Clinical Records of the 
Author. By Joseph Pakrish, m. d., President of the 
American Association for the Care of Inebriates, etc. One 
Volume. i2mo. Price $1.25. 

Contents. 1. Who are Inebriates? 2. The Vice Aspect of 
Inebriety; 3. The Crime Aspect of Inebriety ; 4. Inebriety a 
Disease; 5. The Heredity of Inebriety ; 6. Insanity and In- 
ebriety! How Related; 7. How to Deal with Inebriates. 8. 
Asylums and Reformatories ; 9. The Psychology of Inebriety. 
10. The Conclusion. 

This is the only work of the kind published. The author has 
endeavored to avoid technicalities in the construction of his 
text, so as to make the book easily understood by the non- pro- 
fessional reader, and no one can fail to comprehend the fact that 
the author is addressing himself to the thoughtful and intelligent 
of the community at large. 

ALCOHOL AND TOBACCO. Alcohol; its Place and 
Power. By James Miller, m.d. ; and, Tobacco; its 
Use and Abuse. By John Lizars, m.a. The two essays 
in one volume. Cloth, $1. 00. 

" They are full of good, strong sense, and ought to be influ- 
ential agents against the vices they assault." — Congregation* 
alist. 

DRUGS THAT ENSLAVE. The Opium, Morphine, Chlo- 
ral and Hashisch Habits. By H. H. Kane, m.d., of New 
York City. One volume. i2mo. With Illustrations. 

Paper Cover, 75 cents ; Cloth, $1.25. 



EDWARDS. CONSTIPATION. Plainly Treated and 
Relieved without the Use of Drugs. By Joseph F. Ed- 
wards. i6mo. Cloth, 75 cents. 
" It is one of those useful little books which every one ought 
to read." — Philadelphia Inquirer. 

EDWARDS ON VACCINATION AND SMALLPOX. 
Showing the reasons why we should be vaccinated, and the 
fallacy of arguments advanced against it, with hints as to 
the management and care of smallpox patients. 32mo. 

Cloth, 50 cents. 
MALARIA. Where Found ; Its Symptoms and How to Avoid 
It. By Joseph F. Edwards, m.d. Cloth, 75 cents. 

"A forcible, logical and sensible little book." — Philadelphia 
Times. 

BRIGHT'S DISEASE. How Persons Threatened or Afflic- 
ted with this Disease Ought to Live. By J. F. Edwards, 
m.d. Second Edition. i6mo. Cloth, 75 cents. 

" It encourages the sufferer, as well as instructs him." — C#n- 
gregationalist. 



Popular Medicine ; Books on General Health, etc. 3 

EYESIGHT, HEADACHES, INDIGESTION. 
CARTER. EYESIGHT, GOOD AND BAD. The 

Preservation of Vision. By Robert Brudenel Carter, 
m.d., f.r.c.s. Second Edition. With many Explanatory 
Illustrations. i2mo. Paper covers, 75 cents. Cloth, $1.25. 
"To teachers particularly the book is of interest and import- 
ance/' — Educational Weekly. 

HARLAN. EYESIGHT AND HOW TO CARE FOR 
IT. A book for all interested in the best use and preserva- 
tion of their Eyes. Illustrated. Paper, 30 cts. Cloth, 50 cts. 

DAY ON HEADACHES. The Nature, Causes and Treat- 
ment of Headaches. By Wm. H. Day, m.d. Fourth Edi- 
tion. Illustrated. 8vo. Paper covers, 75 cents. Cloth, $1.25. 
"The work is one that will be read with interest by those who 
are called on to treat the disease — and even more by those who 
are at the same time personally acquainted with its tortures." — 
Ohio Medical Recorder. 
WRIGHT ON HEADACHES. Their Causes and their 

Cure. Ninth Thousand. i2mo. Cloth, 50 cents. 

LEARED. IMPERFECT DIGESTION. Its Causes and 
Treatment. By Arthur Leaked, m.d., Member of the 
Royal College of Physicians of London. Seventh Edition. 
i2mo. Cloth, $2.00. 

MISCELLANEOUS. 
ACTON. THE REPRODUCTIVE ORGANS. The 
Functions and Disorders of the Reproductive Organs, in 
Childhood, Youth, Adult Age, Advanced Life ; considered 
in their Physiological, Moral and Social Relations. By 
Wm. Acton, m.d. Sixth Edition. Revised and Enlarged. 

$2.00. 
"In the work now before us all essential detail upon its sub- 
ject matter is clearly and scientifically given. We recommend 
it accordingly, as meeting a necessary requisition of the day, 
refusing to join in that opinion which regards the consideration 
of the topics in question as beyond the duties of the medical 
practitioner." — The London Lancet. 

WALKER ON INTERMARRIAGE. A Scientific Inquiry 
into the Causes why Beauty, Health and Intellect result 
from certain unions, and Deformity, Disease and Insanity 
fromothers. By Alexander Walker. Illustrated. 121110. 

Cloth, $1. 00. 
The work is not of that empiric character which its title 
might lead some readers to suppose ; but a careful philosophical 
treatise. It is entitled to great consideration. There is nothing 
indelicate in the work, to an enlightened reader. 

RYAN. THE PHILOSOPHY OF MARRIAGE. In 

its Social, Moral and Physical Relations. By Dr. Michabl 
Ryan, Member of the Royal College of Physicians and 
Surgeons, London. i2mo. Cloth, $1.00. 



The Care of Children. 



ON THE CARE OF CHILDREN. 

MRS. HALE'S MANAGEMENT OF CHILDREN in 

Health and Disease. By Mrs. Amie M. Hale, m.d. A 
book for Mothers. 2d Edition. i2mo. Cloth, 75 cents. 

THE PRESS COMMEND IT AS FOLLOWS I 

" Altogether, it is a book which ought to be put into every 
baby basket, even if some lace-trimmed finery is left out, and 
should certainly stand on every nursery bureau." — Philadel- 
phia Public Ledger. 

" Admirable common-sense advice, which mothers would 
do well to have." — Southern Churchman. 

" Contains invaluable instruction." — Evening News , Detroit . 

" The importance of this book cannot be over-estimated." — 
N. E. yournal of Education. % 

"A work for mothers, full of wisdom." — Congregationalist. 

ELLIS. WHAT EVERY MOTHER SHOULD KNOW. 

By Edward Ellis, m.d., Author of a Practical Manual on 
the Diseases of Children. i6mo. Cloth, 75 cents. 

" He is eminently a practitioner among doctors, and a doctor 
among practitioners ; that is to say, he is learned and well 
knows what is known, can do what should be done, and can 
put what he has to say in plain and comprehensive language." 
Pall Mall Gazette. 

" The author has a faculty of sketching out the character- 
istics of diseases and their treatment in striking outlines, and 
of making his points very clear and impressive." — N. Y. 
Medical Record. 

CHAVASSE. THE MENTAL CULTURE AND 

TRAINING OF CHILDREN. By Pye Henry Cha- 

vasse. i2mo. #1.00. Paper Cover, 50 cents. 

The mental culture and training of children is of immense 

importance. Many children are so wretchedly trained, or 

rather, not trained at all, and so mismanaged, that a few 

thoughts on this subject cannot be thrown away, even upon 

the most careful. 

LARGER WORKS FOR REFERENCE. 

MEIGS AND PEPPER. Diseases of Children. 7 th Ed. $6.00. 
DAY. On the Diseases of Children. 2d Edition. $5.00. 
ELLIS. Manual of the Diseases of Children. 4th Ed. $3.00. 
TANNER. Diseases of Infancy and Childhood. $3.00. 
HILLIER'S Clinical Treatise on Children. $1.00. 



2 Popular Medicine ; Books on General Health, etc. 

SLIGHT AILMENTS: THEIR NATURE AND 

TREATMENT. By Lionel S. Beale, m. d. Second 

Edition,Revised and Enlarged. With Illustrations. Octavo. 

Cloth, $1.25. Paper Covers, 75 cents. 

Finer Edition, in Heavy Cloth Binding, $i.7S- 

Every one suffers from time to time with slight derangements 
of the health ; derangements not dependent upon or likely to 
determine any important change in any organ or tissue of the 
body, but due to some temporary disturbance which, though 
painful and unpleasant, may be easily relieved by any one un- 
derstanding their nature and cause. 

A little too much food, or food of a bad kind, or food badly 
cooked, or eaten at the wrong time or too quickly, a glass of 
bad wine, bad milk or water, to say nothing of the disturb- 
ances occasioned by changes of atmosphere, and a hundred 
other causes, bring about such normal changes in the body as 
to make even the strongest and healthiest among us to feel for a 
time unwell ; almost every one, in fact, experiences such depar- 
tures from the healthy condition. It is about these slight ail- 
ments, which cause so much discomfort, and often a great deal 
of pain, that Dr. Beale treats. The old adage, that "prevention 
is better than cure," applies pertinently to slight ailments, as it 
is these which are often the forerunners of disease and doctors' 
bills. 

Summary of Contents. — Slight Ailments and Civilization ; 
Character of the Tongue in Health and Disease; Appetite; 
Nausea ; Thirst ; Hunger ; Indigestion, its Nature and Treat- 
ment; Constipation; Diarrhoea ; Vertigo ; Giddiness; Bilious- 
ness ; Sick Headaches and their Treatment, etc. ; Intestinal 
Worms ; Neuralgia and Rheumatism ; Fevers and Inflamma- 
tions. With Treatment. 

OPINIONS OF THE PRESS. 

" It abounds in information and advice, and is written for 
popular use/' — Philadelphia Bulletin. 

"A valuable work for the family library." — Boston Tran- 
script. 

"Clear, practical, and a valuable instructor." — Baltimore 
Gazette. 

" In a very important sense, a popular book. — Chicago Ad- 
vance. 

" An admirable treatise upon the minor ills which flesh is heir 
to." — Springfield Republican. 

HUFELAND. THE ART OF PROLONGING LIFE. 

New Edition. Edited by Erasmus Wilson, m.d. i2mo. 

Cloth, $1.00. 
"We all desire long life, and the attainment of that object, as 
far as it can be accomplished by an adherence to the laws pre- 
scribed by nature, may be furthered by a perusal of Dr. Hufe- 
land's book, which is written in a style so as to be readily 
comprehended by non-professional readers." — Philadelphia 
livening Bulletin. 



1 6 Miscellaneous. 



THE DEFECTS OF SPEECH, STAMMERING, ETC. 

Their Definitions, Varieties and Treatment. By S. O. L. 

Potter, m.a., m.d. i2mo. Cloth, $1.00. 

" Parents, guardians and teachers of children afflicted with 

any form of speech defect will find Dr. Potter's thesis worthy 

of thoughtful attention." — Chicago Evening World. 

"The course of Treatment is laid down in detail." — Cincin- 
nati Commercial. 

LONGLEY'S POCKET MEDICAL LEXICON. A 

Pocket Medical Dictionary, Giving the Correct Defini- 
tion and Pronunciation of all Words and Terms in General 
Use in Medicine and the Collateral Sciences, with an Ap- 
pendix, containing Poisons and their Antidotes, Abbrevi- 
ations Used in Prescriptions, and a Metric Scale of Doses. 
By Elias Longley. 

Tucks and Pocket, $1.00; Cloth, $1.25. 

WOAKES. ON DEAFNESS, GIDDINESS AND 
NOISES IN THE HEAD; Or, The Naso-Pharyngeal 
Aspect of Ear Disease. By Edward Woakes, m.d. , Senior 
Aural Surgeon to the Hospital for Diseases of the Throat 
and Chest. Third Edition. Revised and Enlarged, with 
Additional Illustrations. i2mo. 
" This book, although small, is evidently the result of much 
careful thought and observation. . . . We cordially recom- 
mend the work as original and suggestive, and as being likely 
to prove very useful in explaining both the causation of symp- 
toms otherwise puzzling, and their appropriate treatment." — 
London Practitioner. 

GILL ON INDIGESTION. Indigestion: What It Is: 
What It Leads To ; and a New Method of Treating It. 
By John Beadnell Gill, m.d. Third Edition. i2mo. 

Inpreparation. 
Jlgsf Any book in this Catalogue will be sent, free of postage, 
to any address, upon receipt of the price ; or they may be ob- 
tained through any bookseller in the United States or Canada. 
Correspondence solicited. 

P. BLAKISTON, SON & CO., 
Publishers, Booksellers, and Importers, 

MEDICAL AND SCIENTIFIC WORKS, 
No. 1012 Walnut Street, Philadelphia. 

*#* See first page for Index of Subjects. 








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